Abstract
Background: Immunotherapy has revolutionised the management of metastatic melanoma, however, immune-related adverse events remain an important complication of therapy. We hypothesise pyrexia is a rare presentation that may herald the development immune-related toxicities and identify a potential role for fluorodeoxyglucose-positron emission tomography (FDG -PET) in the earlier diagnosis of these toxicities. Case Presentation: We report a case of a 54-year-old man with metastatic melanoma, on combination immunotherapy with ipilumimab and nivolumab, where several days of fever heralded the development of clinical enterocolitis. He ultimately required treatment with infliximab with quick resolution of his symptoms. FDG- PET imaging performed as a work up for his pyrexia demonstrated extensive entero-proctocolitis and a follow up FDG-PET 3 months post infliximab demonstrated complete resolution of the entero-proctocolitis and ongoing complete extracranial response of the melanoma. Conclusion: Early FDG-PET in patients with unexplained pyrexia on immunotherapy may help in an earlier diagnosis of immune-related toxicities allowing prompt initiation of therapy and a reduction in morbidity and mortality associated with these treatments.
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