
==== Front
Gastro Hep Adv
Gastro Hep Adv
Gastro Hep Advances
2772-5723
Elsevier

S2772-5723(24)00084-0
10.1016/j.gastha.2024.06.004
Images of the Month
Linked Color Imaging Highlights Pembrolizumab-Associated Esophagitis
Kubo Kimitoshi kubotti25@yahoo.co.jp
1∗
Ashida Issei 1
Kimura Noriko 2
1 Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
2 Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
∗ Correspondence: Address correspondence to: Kimitoshi Kubo, MD, PhD, Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, 18-16 Kawahara-cho, Hakodate 041-8512, Hokkaido, Japan. kubotti25@yahoo.co.jp
21 6 2024
2024
21 6 2024
3 6 853854
23 5 2024
3 6 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcA 69-year-old man with lung adenocarcinoma (stage IV, cT0N3M1c) was treated with 4 cycles of carboplatin, pemetrexed (PEM) and pembrolizumab therapy, followed by maintenance therapy with PEM plus pembrolizumab, which was discontinued after 9 cycles due to grade 3 nausea and anorexia leading to esophagitis being suspected. However, the symptoms persisted despite switching from esomeprazole (15 mg) once daily he had been taking to vonoprazan (20 mg) once daily.

Esophagogastroduodenoscopy revealed erythema and mild erosive lesions in the lower esophagus on white light imaging (Figure A), highlighted as purple and whitish on linked color imaging (Figure B) and as brownish on blue laser imaging (Figure C). A tissue biopsy revealed marked inflammatory cell infiltration but no evidence of infection or malignancy (Figure D). The patient was thus diagnosed with esophagitis as an immune-related adverse event and was successfully treated with intravenous methylprednisolone.

Esophagitis is a rare immune-related adverse event, and its endoscopic features remain poorly described. Linked color imaging highlighted the differences in color between the lesions and the surrounding normal mucosa and proved helpful in diagnosing PEM-associated esophagitis even under acid inhibition. The endoscopic images given here should offer a clear presentation of the case and serve as reference for endoscopists.

Conflicts of Interest: The authors disclose no conflicts.

Funding: The authors report no funding.

Ethical Statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.

Reporting Guidelines: CARE.
