Autonomic enteric neuropathy following nivolumab monotherapy in a patient with Lung Cancer

Immunotherapy has revolutionized medical oncology by providing durable responses in a number of malignancies. Programmed death-1 inhibitors are rapidly gaining popularity and increased use. They are also associated with a variety of adverse reactions. Although PD-1 inhibitors are generally tolerated relatively well and usually have milder side effects than chemotherapy, the risk remains for immune mediated adverse reactions. Caution should be exercised when re-challenging grade three or four adverse effects with the same agent or a different agent of the same class. The reemergence of a previous toxicity may occur or new toxicity. Immune related adverse events affect the nervous system and effects are generally mild however this case describes an exotic, fatal outcome in a patient with severe enteric neuropathy.