AUTHOR=Leblanc Julie , Hoibian Solene , Boucraut Agathe , Ratone Jean-Philippe , Stoffaes Louis , Dano Domitille , Louvel-Perrot Delphine , Chanez Brice , Chretien Anne-Sophie , Madroszyk Anne , Rochigneux Philippe 

TITLE=Celiac Disease After Administration of Immune Checkpoint Inhibitors: A Case Report

JOURNAL=Frontiers in Immunology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.799666

DOI=10.3389/fimmu.2021.799666

ISSN=1664-3224

ABSTRACT=Immune checkpoint inhibitors (ICI) reinvigorate immune system to recognize and destroy tumor cells. Because of this biological mechanism, patients might develop auto-immune toxicities, notably in digestive tract (most frequently, hepatitis or colitis). A 70-year old man with relapsed mesothelioma was treated by Nivolumab in 3rd line. He was hospitalized for watery and foul smelling diarrhea. He underwent gastro-intestinal endoscopy showing duodenitis and villous atrophy and measurement of serum IgA antibodies to tissue transglutaminase (tTG-IgA+), leading to the diagnosis of ICI-induced celiac disease. He was treated by steroids, proton pump inhibitor and gluten-free diet. If ICI-induced celiac disease is rare in the literature, increasing reports suggest that celiac disease might represent an under-estimated ICI toxicity. This case highlights the necessity of complementary investigation (including tTG-IgA and endoscopic biopsies) in patients with atypical digestive symptoms during immunotherapy.