A Case of Immunotherapy-Induced Colitis Complicated byPerforation and Treated with Infliximab Postoperatively

The advent of checkpoint inhibitor therapy in medical oncology has led to an increase in hospitalizations for immune-relatedadverse effects. Severe colitis has been reported in approximately 5% of patients treated with cytotoxic T-lymphocyte-associatedantigen-4 (CTLA-4) inhibitors, such as ipilimumab. Standard management for those with severe colitis includes administrationof systemic corticosteroids with the reservation of antitumor necrosis factor (anti-TNF) therapy, such as infliximab, if there hasbeen no improvement. Rarely, immunotherapy-induced colitis can become life-threatening and result in bowel perforationrequiring surgical intervention. Yet, there are no specific recommendations for medical management following colectomy inthese situations. In cases of severe colitis from Crohn’s disease, postoperative treatment with infliximab has been found to besafe when administered shortly after intestinal resection. However, there remains limited data to support administration ofinfliximab following bowel perforation due to immunotherapy-induced colitis. Our case illustrates management of a severeadverse reaction to checkpoint inhibitor therapy and the need to further evaluate the role of infliximab postoperatively inpatients who develop colitis complicated by bowel perforation.