Pneumatosis Intestinalis, Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, and Pneumobilia After Pembrolizumab Therapy: A Case Report

Immune checkpoint inhibitors (ICIs) are becoming increasingly popular in treating cancers resistant to traditional chemotherapy. While ICIs have shown promise in treating cancer, the class of drugs also comes with certain risks, such as the development of pneumatosis intestinalis (PI) in rare cases....

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Published inCurēus (Palo Alto, CA) Vol. 16; no. 3; p. e55972
Main Authors Calenda, Charles D, Toohey, Cameron R, Levy, Madeline, Bhardwaj, AyJy, Ubhi, Jaspreet, Sharma, Arunima, Abou Rizk, Fady
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 11.03.2024
Cureus
Subjects
Abdomen
Breast cancer
Cancer therapies
Case reports
Colon
Constipation
Drug dosages
Emphysema
Etiology
Females
General Surgery
Immunotherapy
Internal Medicine
Ischemia
Laparotomy
Lung diseases
Methadone
Monoclonal antibodies
Mortality
Narcotics
Oncology
Patients
Permeability
Substance use disorder
Targeted cancer therapy
treatment or management challenges
pneumatosis intestinalis
rare disease or condition
unexpected events
immune checkpoint inhibitor (ici)
unusual combination of conditions
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Summary:Immune checkpoint inhibitors (ICIs) are becoming increasingly popular in treating cancers resistant to traditional chemotherapy. While ICIs have shown promise in treating cancer, the class of drugs also comes with certain risks, such as the development of pneumatosis intestinalis (PI) in rare cases. Pembrolizumab, an ICI that inhibits programmed cell death protein 1 (PD-1), has, in some rare instances, caused PI. Patients with ICI-induced PI may also present with pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and pneumobilia. In the current report, we describe the presentation and management of a 50-year-old female with initial complaints of diffuse abdominal pain, constipation, abdominal distension, nausea, and decreased urine output approximately six months after beginning pembrolizumab and two months after the most recent dose of pembrolizumab. Subsequent CT imaging revealed massive PI with pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and pneumobilia suspected to be secondary to pembrolizumab. Here, we discuss the possible mechanisms of ICI-induced PI and evaluate the management of patients presenting with PI and pneumoperitoneum.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.55972