Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2020; 26(16): 1971-1978
Published online Apr 28, 2020. doi: 10.3748/wjg.v26.i16.1971
Severe steroid refractory gastritis induced by Nivolumab: A case report
Helene Hjorth Vindum, Jørgen S Agnholt, Anders Winther Moelby Nielsen, Mette Bak Nielsen, Henrik Schmidt
Helene Hjorth Vindum, Anders Winther Moelby Nielsen, Henrik Schmidt, Department of Oncology, Aarhus University Hospital, Aarhus 8200, Denmark
Jørgen S Agnholt, Department of Gastroenterology, Aarhus University Hospital, Aarhus 8200, Denmark
Mette Bak Nielsen, Department of Pathology, Aarhus University Hospital, Aarhus 8200, Denmark
Author contributions: Schmidt H and Agnholt JS diagnosed and treated the patient; Vindum HH and Nielsen AWM did the literature research and manuscript preparations; Nielsen MB did the pathologic analysis, and Vindum HH drafted the manuscript; Schmidt H, Agnholt JS, and Nielsen MB contributed to manuscript drafting and revision; All authors issued final approval for the submitted version.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Helene Hjorth Vindum, MD, Senior Registar, Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus 8200, Denmark.
Received: February 7, 2020
Peer-review started: February 7, 2020
First decision: February 27, 2020
Revised: March 5, 2020
Accepted: April 18, 2020
Article in press: April 18, 2020
Published online: April 28, 2020
Processing time: 80 Days and 15.4 Hours

Immune checkpoint inhibitors are widely used for treatment of many advanced malignancies. Lower gastrointestinal (GI) side effects, such as diarrhea and colitis, are common, but upper GI side effects are rarely reported. Consequently, the correct treatment of upper GI adverse events has been less frequently described.


We describe a case of a 16-year-old woman with stage IIIb malignant melanoma treated with adjuvant monotherapy using Nivolumab. The patient developed severe gastritis after six series of Nivolumab with weight loss, nausea, and vomiting. There was no effect of intravenous steroids, but the patient´s condition resolved after administration of Infliximab.


This case report supports the same treatment for gastritis as for colitis, which is in line with current guidelines.

Keywords: Gastritis, Immune checkpoint inhibitors, Nivolumab, Case report, Immune-related adverse events, Infliximab

Core tip: Lower gastrointestinal side effects, such as diarrhea and colitis, caused by immune checkpoint inhibitors are well described, but upper gastrointestinal side effects are less frequently reported. Here, we present a case of severe corticosteroid refractory gastritis induced by Nivolumab. The patient’s symptoms resolved after administration of Infliximab. The treatment was in line with current guidelines for treatment of gastritis.