Severe cytomegalovirus gastritis after pembrolizumab in a patient with melanoma

  • H. Kim Samsung Medical Center, Sungkyunkwan University School of Medicine,
  • S.Y. Ha Samsung Medical Center, Sungkyunkwan University School of Medicine
  • J. Kim Samsung Medical Center, Sungkyunkwan University School of Medicine
  • M. Kang Samsung Medical Center, Sungkyunkwan University School of Medicine
  • J. Lee Samsung Medical Center, Sungkyunkwan University School of Medicine
Keywords: cytomegalovirus gastritis, immunotherapy, pembrolizumab

Abstract

Immunotherapy has emerged as a standard of cancer treatment, with an increasing number of indications. Recently, opportunistic infections have been reported in several cases in which immunotherapy has led to an increased sus­ceptibility to infection. The present case is the first report of cytomegalovirus (cmv) gastritis occurring in a patient with melanoma during immunotherapy without immune-related adverse events (iraes) and without the use of immunosuppressant agents.

A 43-year-old woman presented with stage iii malignant melanoma. She underwent wide excision of skin, with lymph node dissection, and she started immunotherapy with a 3-week cycle of pembrolizumab. The patient demonstrated stable disease response, and no iraes were observed during her initial treatment courses. However, after the 9th treatment cycle, she began to experience epigastric pain that worsened significantly, requiring a visit to the emergency centre. Imaging by computed tomography (ct) and integrated positron-emission tomography/ct revealed severe diffuse gastroduodenitis with acute pancreatitis.

Esophagogastroduodenoscopy showed diffuse oozing, hemorrhagic, edematous, and exfoliative mucosa involv­ing the entire gastric wall, defined as acute hemorrhagic gastritis. Biopsies of the gastric wall revealed cmv infection. Those findings were consistent with a diagnosis of cmv gastritis, and the patient received antiviral therapy with ganciclovir. After treatment, she recovered enough to resume immunotherapy.

       This case report presents a rare occurrence of cmv gastritis related to immunotherapy. As more patients are treated with immunotherapy, incidences of cmv infections are expected to increase; a high index of clinical suspicion is therefore needed in symptomatic patients.


Author Biographies

H. Kim, Samsung Medical Center, Sungkyunkwan University School of Medicine,

Division of Hematology–Oncology, Department of Medicine

S.Y. Ha, Samsung Medical Center, Sungkyunkwan University School of Medicine

Department of Pathology and Translational Genomics

J. Kim, Samsung Medical Center, Sungkyunkwan University School of Medicine

Division of Gastroenterology, Department of Medicine

M. Kang, Samsung Medical Center, Sungkyunkwan University School of Medicine

Division of Gastroenterology, Department of Medicine

J. Lee, Samsung Medical Center, Sungkyunkwan University School of Medicine

Division of Hematology–Oncology, Department of Medicine

Published
2020-03-17
How to Cite
Kim, H., Ha, S., Kim, J., Kang, M., & Lee, J. (2020). Severe cytomegalovirus gastritis after pembrolizumab in a patient with melanoma. Current Oncology, 27(4). https://doi.org/10.3747/co.27.6163
Section
Case Report