Upadacitinib salvage for refractory immune checkpoint inhibitor colitis complicated by cytomegalovirus infection
- Author(s)
- Gondal, F; Abasszade, JH; Murugasu, A; Segal, JP;
- Details
- Publication Year 2026-07-06,Volume 19,Issue #7,Page e275009
- Journal Title
- BMJ Case Reports
- Publication Type
- Case report
- Abstract
- Immune checkpoint inhibitor colitis is a common immune-related adverse event associated with immunotherapy and may be refractory to corticosteroids and biologic therapy. Evidence guiding management beyond anti-tumour necrosis factor and anti-integrin therapy remains limited. We report a case of severe immune checkpoint inhibitor colitis in a man in his 60s with metastatic melanoma treated with combination ipilimumab and nivolumab. Colitis was refractory to corticosteroids, dose-escalated infliximab and vedolizumab. Upadacitinib was commenced with rapid improvement, with stool frequency decreasing from 40 bowel motions per day to 6 within 24 hours. This response was accompanied by a marked decrease in C-reactive protein and faecal calprotectin. His recovery was complicated by cytomegalovirus infection, successfully treated with valganciclovir. A repeat colonoscopy demonstrated complete mucosal healing and the patient achieved durable steroid-free remission following treatment cessation. This case illustrates the potential role of Janus kinase 1 inhibition as a salvage strategy in refractory immune checkpoint inhibitor colitis.
- Publisher
- BMJ
- Keywords
- Humans; *Colitis/drug therapy/chemically induced/complications; *Cytomegalovirus Infections/drug therapy/complications; Male; *Immune Checkpoint Inhibitors/adverse effects; Salvage Therapy/methods; Melanoma/drug therapy; Middle Aged; *Heterocyclic Compounds, 3-Ring/therapeutic use; Ipilimumab/adverse effects; Nivolumab/adverse effects; Valganciclovir/therapeutic use; Treatment Outcome; Antiviral Agents/therapeutic use; Drugs: gastrointestinal system; Immune Checkpoint Inhibitors; Infection (gastroenterology)
- Department(s)
- Surgical Oncology; Internal Medicine
- Publisher's Version
- https://doi.org/10.1136/bcr-2026-275009
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-08-04 04:43:04
Last Modified: 2026-08-04 04:43:19