Severe Lupus Enteritis Complicated by Intractable Gastrointestinal Hemorrhage.

Lupus enteritis (LE) is a rare presentation of systemic lupus erythematosus manifesting with nonspecific symptoms, laboratory derangements, and imaging findings. Rarely, LE may progress to bowel perforation, hemorrhage, and even death. Treatment with systemic glucocorticoids often results in rapid clinical improvement, but patients may require further immunosuppression. We present a case of severe LE complicated by life-threatening intractable gastrointestinal hemorrhage and warm autoimmune hemolytic anemia refractory to glucocorticoids and ultimately requiring massive transfusions, intravenous immunoglobulin, and plasmapheresis. This case illustrates the importance of early specialist involvement and treatment with intravenous immunoglobulin and plasmapheresis for severe, life-threatening LE.

Implementing an immunotherapy toxicity (IOTOX) GI service improves outcomes in patients with immune-mediated diarrhea and colitis.

PURPOSE: Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but can lead to GI toxicity, termed immune-mediated diarrhea and colitis (IMDC). Standardization of IMDC management and early GI consultation is imperative to control symptoms and prevent delays in cancer care. Therefore, we implemented an inpatient algorithm and a focused IOTOX GI service to measure outcomes. METHODS: Patients who received ICIs and were hospitalized with severe IMDC were grouped into a pre-interventional cohort in 2017, followed by implementation of the standardized algorithm in 2018, and then a post-interventional cohort of patients in 2019. Clinical data and patient outcomes were compared using univariate and multivariate analysis to determine the morbidity, and overall survival. RESULTS: Our sample comprised 126 hospitalized patients with IMDC, with 59 patients in the pre-interventional 2017 cohort, and 67 patients in the post-interventional 2019 cohort. We found no significant differences in the clinical severity of IMDC symptoms between the two cohorts (p = 1.03) or median time from ICI exposure to development of IMDC (p = 0.495, respectively). After implementing the standardized algorithm, we observed higher rates of GI consultation (p < 0.001) in the post-treatment group. Patients in the post-treatment cohort showed decreased time to clinical remission (4 vs 10 days, p = 0.046), higher rate of GI follow-up after hospital discharge (p = 0.038), fewer hospital re-admissions (p = 0.002), and significantly fewer recurrences of IMDC symptoms (p = 0.002). Overall survival was significantly higher for at least 2 years in patients who followed with GI post-discharge compared to those without follow-up (p = 0.003). CONCLUSION: Prompt GI consultation and monitoring of IMDC using a regimented approach can provide efficacious management, decrease time to clinical remission of symptoms, decrease re-admissions to the hospital, and improve overall patient outcomes.

An Unusual Case of Biliary Obstruction Because of Human Papillomavirus-Associated Metastatic Squamous Cell Carcinoma From Head and Neck Primary.

Secondary pancreatic tumors are uncommon, with the majority originating from primary gastrointestinal or lung cancers. We present the case of a 42-year-old woman with squamous cell carcinoma of the pancreas, found to be human papillomavirus-positive on in situ hybridization. After extensive work-up, the patient was determined to have a previously undiagnosed, asymptomatic head and neck primary malignancy. There is sparse literature discussing metastatic human papillomavirus-positive squamous cell carcinoma to the pancreas. This report highlights the importance of including this diagnosis when considering a differential for secondary pancreatic tumors, especially squamous etiology.