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research-article2014

AOPXXX10.1177/1060028014528152Annals of PharmacotherapyMerrill et al

Case Report

Early Administration of Infliximab for Severe Ipilimumab-Related Diarrhea in a Critically Ill Patient

Annals of Pharmacotherapy 2014, Vol. 48(6) 806­–810 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028014528152 aop.sagepub.com

Steven P. Merrill, BA1, Paul Reynolds, PharmD1, Avash Kalra, MD2, Jason Biehl, MD2, R. William Vandivier, MD2, and Scott W. Mueller, PharmD1

Abstract Objective: To report a case of ipilimumab-associated life-threatening diarrhea responding quickly to a single dose of infliximab. Case Summary: A 67-year-old man presented 3 weeks after his second dose of ipilimumab with severe diarrhea, acute kidney injury, and hypotension. After 2 days of high-dose corticosteroids and supportive care, he continued to have 2.8 L of stool output per day (grade 4 National Cancer Institute Common Terminology Criteria for Adverse Events). The patient was transferred to the medical intensive care unit requiring endotracheal intubation because of concerns of worsening mental status, metabolic acidosis, and increased work of breathing, with a serum bicarbonate concentration of