ArticleHCA healthcare journal of medicine2025
Pembrolizumab-Associated Acute Esophageal Necrosis: A Case Report and Literature Review.
Article in HCA healthcare journal of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. They pose challenges, particularly in the form of immune-related adverse events (irAEs). Although cases of gastrointestinal irAEs have been well-documented, acute esophageal necrosis (AEN) characterized by a circumferential blackening and fragility of the esophagus, weeks after immunotherapy discontinuation, has not been reported. Case Presentation: A 75-year-old diabetic male who was recently diagnosed with high-grade papillary urothelial cancer with liver and retroperitoneal metastases and had undergone radical cystectomy with ileal conduit urinary diversion, presented to the hospital for sepsis secondary to a urinary tract infection. While in the hospital, he experienced hematemesis, with an acute drop in hemoglobin from 10.6 to 5.3 g/L and a rise in serum lactate from 1.5 to 3.6 mmol/L. An esophagogastroduodenoscopy (EGD) revealed diffuse circumferential eschar, exudate, and inflammation. He was diagnosed with acute esophageal necrosis (AEN), which was found to be secondary to his pembrolizumab use. Conclusion: Immune-related adverse events will remain a challenge in patients receiving ICI therapy. AEN is a rare life-threatening irAE associated with ICIs. Further research is warranted to clarify the exact mechanism of injury, optimal treatment strategies, and possible preventative measures.
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