Nivolumab-associated active neutrophilic gastritis.

In recent years, the increasing use of immune checkpoint inhibitors for the treatment of multiple metastatic malignancies has revealed a wide spectrum of immune-related adverse events (irAEs), many of which are managed by the gastroenterologist.1–3 Among all gastrointestinal (GI)-irAEs, while colitis has been extensively described, gastritis has only been sporadically reported.3–5 We here describe the endoscopic and histopathological features of an acute nivolumab-induced gastritis, before and after oral corticosteroid therapy. A 57-year-old woman, affected by metastatic clear cell renal carcinoma treated with twelve cycles of nivolumab with complete response, had epigastric pain and loss of appetite. She underwent an upper gastrointestinal endoscopy (UGIE) which revealed diffuse, geographical ulcerations covered with whitish fibrin-like membranes, with surrounding erythematous friable mucosa (figure 1). Oesophagus and duodenum were macroscopically normal. In both antrum and corpus biopsies, histology showed a chronic active Helicobacter pylori - …