A Very Rare Case of Esophagitis Due to Nivolumab Immunotherapy

Abstract

A 72-year-old woman with Renal Cell Carcinoma, on Nivolumab therapy for extensive metastatic disease, presented with dysphagia. Endoscopy revealed Grade 2 esophagitis with biopsy confirming active esophagitis. There was no histological evidence of an infectious or lymphoproliferative etiology. Nivolumab-induced esophagitis was suspected, and the medication was discontinued. There was dramatic clinical improvement with steroids. Immune checkpoint inhibitors are novel immunotherapeutic agents designed to restore the patient's own antitumor immune responses. Nivolumab, an IgG4 monoclonal antibody that acts as an inhibitor of programmed death-1, is currently approved for clinical use in treatment of advanced stage malignancies. As Nivolumab is increasingly used in clinical oncology due to its efficacy and better tolerance compared to other chemotherapeutic agents, we present the second reported case of Nivolumab-associated esophagitis. Pathologists and clinicians should be aware of this possible complication to ensure its timely diagnosis and management.