The Drug-Induced Respiratory Disease Website

Nivolumab

Esophageal toxicity

Including esophagitis, esophageal ulceration, stricture or fistula. This cause mediastinitis as a secondary complication

Figuero Pérez L, Olivares-Hernández A, Amores-Martín A, Cruz-Hernández JJ, Fonseca-Sánchez E

Acute esophageal necrosis induced by immune checkpoint inhibitors.

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva 2021 Nov 16;; — 2021 Nov 16

Horisberger A, La Rosa S, Zurcher JP, Zimmermann S, Spertini F, Coukos G, Obeid M

A severe case of refractory esophageal stenosis induced by nivolumab and responding to tocilizumab therapy.

Journal for immunotherapy of cancer 2018 12 27;6;156 — 2018 12 27 — 156

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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