Pembrolizumab-induced Focal Pancreatitis Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration

Juri Ikemoto; Yasutaka Ishii; Masahiro Serikawa; Tomofumi Tsuboi; Ken Tsushima; Shinya Nakamura; Tetsuro Hirano; Yusuke Kiyoshita; Sho Saeki; Yosuke Tamura; Sayaka Miyamoto; Kazuki Nakamura; Masaru Furukawa; Koji Arihiro; Hiroshi Aikata

doi:10.2169/internalmedicine.8507-21

CASE REPORTS

Pembrolizumab-induced Focal Pancreatitis Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration

Juri Ikemoto, Yasutaka Ishii, Masahiro Serikawa, Tomofumi Tsuboi, Ken Tsushima, Shinya Nakamura, Tetsuro Hirano, Yusuke Kiyoshita, Sho Saeki, Yosuke Tamura, Sayaka Miyamoto, Kazuki Nakamura, Masaru Furukawa, Koji Arihiro, Hiroshi Aikata

Author information

Juri Ikemoto
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Yasutaka Ishii
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Masahiro Serikawa
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Tomofumi Tsuboi
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Ken Tsushima
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Shinya Nakamura
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Tetsuro Hirano
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Yusuke Kiyoshita
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Sho Saeki
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Yosuke Tamura
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Sayaka Miyamoto
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Kazuki Nakamura
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Masaru Furukawa
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Koji Arihiro
Department of Anatomical Pathology, Hiroshima University Hospital, Japan
Hiroshi Aikata
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan

Keywords: pembrolizumab, pancreatitis, immune-related adverse event, EUS-FNA

JOURNAL OPEN ACCESS

2022 Volume 61 Issue 16 Pages 2463-2469

DOI https://doi.org/10.2169/internalmedicine.8507-21

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Abstract

A 69-year-old man with advanced non-small-cell lung cancer was treated with pembrolizumab for 4 months. Three months after pembrolizumab was discontinued, computed tomography showed enlargement of the pancreatic head, with hypoattenuating areas in the pancreatic head to body. On endoscopic ultrasonography, the entire pancreatic parenchyma was hypoechoic. Endoscopic retrograde cholangiopancreatography showed narrowing of the main pancreatic duct at the pancreatic head. Endoscopic ultrasound-guided fine-needle aspiration showed inflammatory cell infiltration in the stroma but no neoplastic lesions. CD8-positve T cells were dominant over CD4-positive T cells in the infiltrating lymphocytes, and the patient was diagnosed with pembrolizumab-induced pancreatitis.

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