The patient was a 63-year-old male with chronic hepatitis B for 40 years, cirrhosis for 10 years, duodenal varicose vein sclerosis, type 2 diabetes for 5 years, and thrombocytopenia for 5 years.
In June 2018, the patient was diagnosed with hepatocellular carcinoma and undergone right lobe hepatectomy. Sorafenib 400mg bid was taken orally for 6 months after operation. On November 1, 2018, the electronic colonoscope showed multiple telangiectasia of the colon. In June 2019, percutaneous transhepatic portal vein and duodenal vein embolization was performed once. In August 2020, pulmonary metastasis and mediastinal lymph node metastasis were observed. Bronchial artery infusion (BAI) and splenic artery infusion chemotherapy were performed three times on September 29 and November 13, 2020, with regimen consisted of pirarubicin 60mg, fluorouracil 750mg, oxaliplatin 50mg and interleukin 2 million IU, and on December 18, 2020, with regimen consisted of gemcitabine 1g and cisplatin 40mg. The patient was also treated with 200mg of camrelizumab for four courses from September 14, 2020, to March 29, 2021. After 21 days of the last dose of camrelizumab, diarrhea appeared and gradually worsened with 5 to 6 episodes of thin mucus and bloody stools from April 19, 2021, but without abdominal pain. The blood cell analysis showed: white blood cell count (WBC) 2.93x109/L, platelet count (PLT) was 72x109/L, hemoglobin (HB) was 138g/L and C-reactive protein was 4.42 mg/L.
Afterwards, patient was admitted to hospital. His lab profile revealed alanine aminotransferase (ALT): 28U/L, serum total bilirubin (Tbil): 32.43 umol/L, serum creatinine (Cr): 45.8 umol/L, hepatitis B surface antigen (HBsAg): 0.6IU/mL. Hepatitis C antibody was negative indicated that Hepatitis C infection was excluded. Routine stool on April 21 showed brown loose stool with OB+ and red blood cell (RBC) 2/HP. No pathogenic bacterium grew in a stool culture, so we excluded infection. Abdominal CT showed there were no morphologic abnormalities of colon and rectum. Immunotherapy was interrupted. On April 23, 2021, colonoscopy showed multiple flake congestion and edema in the terminal ileum and colon mucosa. Histopathological evaluation showed chronic inflammation of colonic mucosa (Figure 1). On April 24, loperamide 5mg bid as a symptomatic treatment was given. The patient has shown improvement, with a decrease in mucus and non-bloody diarrhea to once a day. After oral administration of enteric-coated sulfasalazine capsule, 0.25g bid was given for 6 weeks, diarrhea and bloody stool disappeared. On June 8, 2021, colonoscopy showed congestion and edema of colonic mucosa, and scattered patchy erythema mainly in descending colon and sigmoid colon. The biopsy specimens were taken from the erythematous mucosa of transverse colon (Figure 1). Pathological evaluation showed chronic inflammation of colonic mucosa and hyperplastic polyp. BAI chemotherapy consisting of gemcitabine 1g, cisplatin 40mg, and interleukin-2200 IU was administered on September 7, 2021. On September 30, immune therapy was resumed. Two hundred milligrams of camrelizumab was given. No obvious discomfort occurred during follow-up. Colonoscopy was performed again in January 2022, and no colonic disease was found.