P3985 - Rare Presentation of Immune Checkpoint Inhibitor Esophagitis: A Case Report

Nabil El Hage Chehade, MD¹, Pooja Magavi, MD¹, Evan Wilder, MD¹, Joy-Marie Hermes, MD², Olivia Lanser, MD³, Fei Bao, MD¹, Ahmed Deabes, MD^1
1Scripps Clinic, San Diego, CA; ²Scripps Clinic & Scripps Research Institute, San Diego, CA; ³Scripps Green Hospital, La Jolla, CA

Introduction: Immune checkpoint inhibitors (ICI) are immunomodulatory antibodies that have improved the prognosis for patients with select advanced malignancies. Nevertheless, they are associated with a unique spectrum of immune-related adverse effects (irAE) through their mechanism of immunologic enhancement. In the following case report, we present a rare case of an irAE presenting as ICI-esophagitis

Case Description/Methods: A 74-year-old male patient with a history of metastatic right auricular melanoma on Pembrolizumab infusions presented to the ED for the evaluation of worsening esophageal dysphagia to both solids and liquids associated with severe odynophagia. CT of the neck and larynx with IV contrast showed non-specific peri-parotid lymphadenopathy. EGD was normal except for faint linear esophageal furrows without any rings, ulcers, or adherent exudates. Esophageal biopsies demonstrated squamous mucosa with markedly increased lymphocytes ( > 50 per HPF), spongiosis and scattered necrotic keratinocytes, consistent with immune checkpoint inhibitor esophagitis. Patient was then started on oral prednisone with remarkable symptomatic improvement, then discharged home on a prednisone taper.

Discussion: Colitis is a well-described irAE related to ICI therapy. However, only a few case reports/series have been published on ICI esophagitis. Literature review demonstrates that patients with ICI esophagitis often have extra-esophageal systemic involvement. Most cases do respond to corticosteroids while refractory cases require biologic therapy. Future studies should aim at describing ICI-esophagitis’ disease characteristics, progression, and prognosis.



Disclosures:


Nabil El Hage Chehade, MD¹, Pooja Magavi, MD¹, Evan Wilder, MD¹, Joy-Marie Hermes, MD², Olivia Lanser, MD³, Fei Bao, MD¹, Ahmed Deabes, MD¹. P3985 - Rare Presentation of Immune Checkpoint Inhibitor Esophagitis: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.