{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:12:56Z","timestamp":1793124776791,"version":"4.5.0"},"reference-count":13,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2026-275009","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:17:36Z","timestamp":1783343856000},"page":"e275009","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Upadacitinib salvage for refractory immune checkpoint inhibitor colitis complicated by cytomegalovirus infection"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-9547","authenticated-orcid":false,"given":"Faris","family":"Gondal","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"},{"name":"Department of Gastroenterology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5469-4317","authenticated-orcid":false,"given":"Joshua Haron","family":"Abasszade","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"},{"name":"Department of General Medicine, The Northern Hospital, Epping, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Murugasu","sequence":"additional","affiliation":[{"name":"Department of Pathology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P","family":"Segal","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Victoria, Australia"},{"name":"Department of Gastroenterology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia"},{"name":"School of Medicine, The University of Melbourne, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"2026070606051131000_19.7.e275009.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1703481"},{"key":"2026070606051131000_19.7.e275009.2","doi-asserted-by":"crossref","first-page":"102440","DOI":"10.1016\/j.ctrv.2022.102440","article-title":"Immune checkpoint Inhibitor-Induced diarrhea and Colitis: Incidence and Management. A systematic review and Meta-analysis","volume":"109","author":"Nielsen","year":"2022","journal-title":"Cancer Treat Rev"},{"key":"2026070606051131000_19.7.e275009.3","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.08.063"},{"key":"2026070606051131000_19.7.e275009.4","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2023-008232","article-title":"Management of infliximab refractory immune checkpoint inhibitor gastrointestinal toxicity: a multicenter case series","volume":"12","author":"Harvey","year":"2024","journal-title":"J Immunother Cancer"},{"key":"2026070606051131000_19.7.e275009.5","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-023-41798-2","article-title":"Immune checkpoint inhibitor-induced colitis is mediated by polyfunctional lymphocytes and is dependent on an IL23\/IFN\u03b3 axis","volume":"14","author":"Lo","year":"2023","journal-title":"Nat Commun"},{"key":"2026070606051131000_19.7.e275009.6","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1016\/S0140-6736(22)00581-5","article-title":"Upadacitinib as induction and maintenance therapy for moderately to severely active ulcerative colitis: results from three phase 3, multicentre, double-blind, randomised trials","volume":"399","author":"Danese","year":"2022","journal-title":"The Lancet"},{"key":"2026070606051131000_19.7.e275009.7","doi-asserted-by":"crossref","DOI":"10.14309\/crj.0000000000001847","article-title":"Refractory Immune Checkpoint Inhibitor Colitis Treated With Biologics, Janus Kinase Inhibition, Plasma Exchange, and Fecal Microbiota Transplantation","volume":"12","author":"Hearn","year":"2025","journal-title":"ACG Case Rep J"},{"key":"2026070606051131000_19.7.e275009.8","article-title":"JAK Inhibitor Upadacitinib Induces Remission in Refractory Immune\u2010Related Colitis Triggered by CTLA \u20104 and PD \u20101 Inhibitor Combination Therapy in Malignant Pleural Mesothelioma: A Case Report","volume":"7","author":"Kono","year":"2024","journal-title":"Cancer Rep"},{"key":"2026070606051131000_19.7.e275009.9","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2021-003277","article-title":"Efficacy and safety of vedolizumab and infliximab treatment for immune-mediated diarrhea and colitis in patients with cancer: a two-center observational study","volume":"9","author":"Zou","year":"2021","journal-title":"J Immunother Cancer"},{"key":"2026070606051131000_19.7.e275009.10","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1007\/s12328-023-01826-6","article-title":"Mirroring UC care pathways in refractory immune checkpoint inhibitor (ICI)-mediated colitis: distinct features and common pathways","volume":"16","author":"Sleiman","year":"2023","journal-title":"Clin J Gastroenterol"},{"key":"2026070606051131000_19.7.e275009.11","doi-asserted-by":"crossref","DOI":"10.3390\/cancers16030611","article-title":"The JAK-STAT Pathway as a Therapeutic Strategy in Cancer Patients with Immune Checkpoint Inhibitor-Induced Colitis: A Narrative Review","volume":"16","author":"Gravina","year":"2024","journal-title":"Cancers (Basel)"},{"key":"2026070606051131000_19.7.e275009.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2024.01.024"},{"key":"2026070606051131000_19.7.e275009.13","doi-asserted-by":"crossref","first-page":"105879","DOI":"10.1016\/j.jcv.2025.105879","article-title":"Utility of cytomegalovirus (CMV) qualitative polymerase chain reaction from gastrointestinal biopsies in diagnosis of CMV gastrointestinal disease: A 10-year retrospective study","volume":"181","author":"Schonhofer","year":"2025","journal-title":"J Clin Virol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-275009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:17:37Z","timestamp":1783343857000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-275009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":13,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,6]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2026-275009"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-275009","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}