Therapy with a targeted monoclonal antibodies to CTLA-4 (T-lymphocyte antigen-4, CD152) may be complicated by autoimmune enterocolitis which can be fatal.
Monoclonal antibodies affected include:
(1) ipilimumab (Yervoy)
(2) tremelimumab
Clinical findings of moderate enterocolitis:
(1) abdominal pain
(2) 4 to 6 bowel movements per day over baseline
(3) blood and/or mucus in stool
Clinical findings of of severe enterocolitis:
(1) fever, especially if high
(2) ileus
(3) dehydration requiring intravenous fluids for > 24 hours
(4) stool incontinence or >= 7 bowel movements per day over baseline
(5) bowel perforation
(6) gastrointestinal hemorrhage
(7) need for hospitalization
The diagnosis of autoimmune enterocolitis requires exclusion of infectious colitis.
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