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<p>The upper gastrointestinal tract is a relatively rare site for immune-related adverse events (AEs) associated with immune checkpoint inhibitor treatment. A 79-year-old Japanese male with relapsed hypopharyngeal carcinoma after curative surgery with free-jejunum reconstruction and postoperative irradiation developed multiple lung metastases invading the mediastinum. Four months after the anti-PD-1 inhibitor pembrolizumab was initiated, repeated bleeding episodes occurred in the tracheostoma and mouth. Tumor progression, collapse, and bleeding were not observed on CT. Esophagogastroduodenoscopy identified erosion of the reconstructed free jejunum and esophageal mucosal injury (diagnosed as an immune-related AE) as the bleeding source. A corticosteroid (methylprednisolone) was introduced, resulting in a rapid response. Considering the risk of esophageal perforation/bleeding and the patient’s age, best supportive care and the termination of systemic chemotherapy were recommended. Acute esophagitis as irAE can be fatal, necessitating its early differentiation and corticosteroid treatment. Further clarification of the predilection and time course of this AE is warranted.</p>

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Acute esophageal mucosal injury during pembrolizumab treatment after a hypopharyngeal cancer patient’s free jejunal autograft reconstruction, as an immune-related adverse event

  • 期刊论文

  • 发表日期：

    2025年11月6日

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  • Yuten Shuri,
  • Kenji Nakano,
  • Koichi Takeda,
  • Toru Sasaki,
  • Tetsuya Urasaki,
  • Makiko Ono,
  • Toshiaki Mochizuki,
  • Takahiro Kogawa,
  • Taro Shiga,
  • Shigehisa Kitano,
  • Xiaofei Wang,
  • Hirotaka Suto,
  • Ryosuke Oki,
  • Naoki Fukuda,
  • Junichi Tomomatsu,
  • Hiroki Mitani,
  • Shunji Takahashi,
  • Yuji Miura

摘要

The upper gastrointestinal tract is a relatively rare site for immune-related adverse events (AEs) associated with immune checkpoint inhibitor treatment. A 79-year-old Japanese male with relapsed hypopharyngeal carcinoma after curative surgery with free-jejunum reconstruction and postoperative irradiation developed multiple lung metastases invading the mediastinum. Four months after the anti-PD-1 inhibitor pembrolizumab was initiated, repeated bleeding episodes occurred in the tracheostoma and mouth. Tumor progression, collapse, and bleeding were not observed on CT. Esophagogastroduodenoscopy identified erosion of the reconstructed free jejunum and esophageal mucosal injury (diagnosed as an immune-related AE) as the bleeding source. A corticosteroid (methylprednisolone) was introduced, resulting in a rapid response. Considering the risk of esophageal perforation/bleeding and the patient’s age, best supportive care and the termination of systemic chemotherapy were recommended. Acute esophagitis as irAE can be fatal, necessitating its early differentiation and corticosteroid treatment. Further clarification of the predilection and time course of this AE is warranted.