{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T09:29:11Z","timestamp":1768469351127,"version":"3.49.0"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Soonchunhyaung University Research Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Immune check inhibitor (ICI) colitis is one of most common and adverse side effects of ICI. However, there was no case report of ulcerative colitis (UC)-mimicking colitis after atezolizumab use in hepatocellular carcinoma (HCC) to our knowledge. Materials and Methods: We would like to introduce the case of a patient with Stage IV HCC who complained of abdominal pain, diarrhea and rectal bleeding after two cycles of atezolizumab\/bevacizumab chemotherapy and was then diagnosed with UC-mimicking colitis. Results: Endoscopy revealed typical findings of UC, suggesting diagnosis of UC-mimicking colitis. The patient was treated with systemic steroids and oral mesalamine, which significantly improved his symptoms, which were also supported by endoscopic findings. The patient resumed chemotherapy with atezolizumab and bevacizumab without any interruption to the chemotherapy schedule. Conclusions: Early endoscopic evaluation is pivotal to diagnosing UC-mimicking colitis. If diagnosed, UC-based treatments such as steroids and mesalamine should be strongly considered. Given previous reports of inflammatory bowel disease (IBD) flare-ups after immunotherapy, routine lower endoscopy, performed together with upper endoscopy before atezolizumab\/bevacizumab therapy, is promising to patients.<\/jats:p>","DOI":"10.3390\/medicina60091422","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T06:46:29Z","timestamp":1725000389000},"page":"1422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Atezolizumab-Induced Ulcerative Colitis in Patient with Hepatocellular Carcinoma: Case Report and Literature Review"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5214-7430","authenticated-orcid":false,"given":"Hyuk","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoon E","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hye-Jin","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan 31151, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9628-421X","authenticated-orcid":false,"given":"Jae-Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan 31151, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7802-0381","authenticated-orcid":false,"given":"Jeong-Ju","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-777X","authenticated-orcid":false,"given":"Sang Gyune","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7113-3623","authenticated-orcid":false,"given":"Young Seok","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Liu, C., Yang, M., Zhang, D., Chen, M., and Zhu, D. (2022). Clinical cancer immunotherapy: Current progress and prospects. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.961805"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"316","DOI":"10.17998\/jlc.2023.09.04","article-title":"A multidisciplinary approach with immunotherapies for advanced hepatocellular carcinoma","volume":"23","author":"Lee","year":"2023","journal-title":"J. Liver Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1056\/NEJMoa1915745","article-title":"Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma","volume":"382","author":"Finn","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Korean Liver Cancer Association, and National Cancer Center (NCC) Korea (2023). 2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma. J Liver Cancer, 23, 1\u2013120.","DOI":"10.17998\/jlc.2022.11.07"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1038\/s41571-019-0218-0","article-title":"Adverse effects of immune-checkpoint inhibitors: Epidemiology, management and surveillance","volume":"16","author":"Martins","year":"2019","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9","DOI":"10.17998\/jlc.2023.11.21","article-title":"Complications of immunotherapy in advanced hepatocellular carcinoma","volume":"24","author":"Song","year":"2024","journal-title":"J. Liver Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Song, Y.-G., Yeom, K.-M., Jung, E.A., Kim, S.G., Kim, Y.S., and Yoo, J.-J. (2024). Risk of Bleeding in Hepatocellular Carcinoma Patients Treated with Atezolizumab\/Bevacizumab: A Systematic Review and Meta-Analysis. Liver Cancer, 1\u201311.","DOI":"10.1159\/000539423"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1111\/acem.13443","article-title":"Immune-related Adverse Events in Cancer Patients","volume":"25","author":"Pallin","year":"2018","journal-title":"Acad. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"405","DOI":"10.12998\/wjcc.v7.i4.405","article-title":"Immune checkpoint inhibitor-induced colitis: A comprehensive review","volume":"7","author":"Som","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_10","first-page":"514","article-title":"Immune checkpoint inhibitor-related gastrointestinal toxicity in patients with malignancy involving the luminal gastrointestinal tract and its impact on cancer outcomes","volume":"35","author":"Yu","year":"2022","journal-title":"Ann. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Yamauchi, R., Araki, T., Mitsuyama, K., Tokito, T., Ishii, H., Yoshioka, S., Kuwaki, K., Mori, A., Yoshimura, T., and Tsuruta, O. (2018). The characteristics of nivolumab-induced colitis: An evaluation of three cases and a literature review. BMC Gastroenterol., 18.","DOI":"10.1186\/s12876-018-0864-1"},{"key":"ref_12","first-page":"e25437","article-title":"Refractory Fulminant Colitis Requiring Surgical Intervention in a Patient With Ulcerative Colitis on Atezolizumab Therapy for Small Cell Lung Cancer: An Atypical Case","volume":"14","author":"Steiger","year":"2022","journal-title":"Cureus"},{"key":"ref_13","first-page":"e39538","article-title":"Complete Remission of Advanced Hepatocellular Carcinoma in a Patient with Ulcerative Colitis Treated With Atezolizumab and Bevacizumab: A Case Report","volume":"15","author":"Pentapati","year":"2023","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"A35","DOI":"10.1016\/j.cgh.2017.03.026","article-title":"Nivolumab-Associated Colitis Mimicking Ulcerative Colitis","volume":"15","author":"Kubo","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.2147\/OTT.S383769","article-title":"A Case of Hepatocellular Carcinoma Successfully Resumed Atezolizumab and Bevacizumab After Associated Grade 3 Diarrhea and Grade 2 Colitis: Case Report and Literature Review","volume":"15","author":"Fuji","year":"2022","journal-title":"Onco Targets Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s12328-020-01276-4","article-title":"Collagenous colitis and atezolizumab therapy: An atypical case","volume":"14","author":"Gallo","year":"2021","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Tang, L., Wang, J., Lin, N., Zhou, Y., He, W., Liu, J., and Ma, X. (2021). Immune Checkpoint Inhibitor-Associated Colitis: From Mechanism to Management. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.800879"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s00428-021-03170-x","article-title":"Immune checkpoint inhibitor treatment induces colitis with heavy infiltration of CD8 + T cells and an infiltration pattern that resembles ulcerative colitis","volume":"479","author":"Renken","year":"2021","journal-title":"Virchows Arch."},{"key":"ref_19","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":"ref_20","doi-asserted-by":"crossref","first-page":"e002058","DOI":"10.1136\/jitc-2020-002058","article-title":"Fecal calprotectin concentration to assess endoscopic and histologic remission in patients with cancer with immune-mediated diarrhea and colitis","volume":"9","author":"Zou","year":"2021","journal-title":"J. Immunother. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4291\/wjgp.v10.i2.17","article-title":"Immune checkpoint inhibitor-induced diarrhea\/colitis: Endoscopic and pathologic findings","volume":"10","author":"Nishida","year":"2019","journal-title":"World J. Gastrointest. Pathophysiol."},{"key":"ref_22","unstructured":"Grover, S., Wang, Y., and Dougan, M. (2024). Immune Checkpoint Inhibitor Colitis, UpToDate."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"202","DOI":"10.14309\/ajg.0000000000000497","article-title":"Checkpoint Inhibitor-Induced Colitis","volume":"115","author":"Bellaguarda","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1053\/j.gastro.2021.06.025","article-title":"Interferon-Gamma-Producing CD8(+) Tissue Resident Memory T Cells Are a Targetable Hallmark of Immune Checkpoint Inhibitor-Colitis","volume":"161","author":"Sasson","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1053\/j.gastro.2020.08.063","article-title":"AGA Clinical Practice Update on Diagnosis and Management of Immune Checkpoint Inhibitor Colitis and Hepatitis: Expert Review","volume":"160","author":"Dougan","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e000278","DOI":"10.1136\/esmoopen-2017-000278","article-title":"Immune checkpoint inhibition-related colitis: Symptoms, endoscopic features, histology and response to management","volume":"3","author":"Rozeman","year":"2018","journal-title":"ESMO Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s40425-018-0412-0","article-title":"Infliximab associated with faster symptom resolution compared with corticosteroids alone for the management of immune-related enterocolitis","volume":"6","author":"Johnson","year":"2018","journal-title":"J. Immunother. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s40425-018-0461-4","article-title":"Outcomes of vedolizumab therapy in patients with immune checkpoint inhibitor-induced colitis: A multi-center study","volume":"6","author":"Ali","year":"2018","journal-title":"J. Immunother. Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1056\/NEJMc2031717","article-title":"Ustekinumab for Refractory Colitis Associated with Immune Checkpoint Inhibitors","volume":"384","author":"Ma","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_30","first-page":"567","article-title":"Severe and refractory gastrointestinal toxicity due to immune checkpoint inhibitors: Clinical experience in a tertiary referral hospital","volume":"115","author":"Mayorga","year":"2023","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_31","first-page":"356","article-title":"Ustekinumab for corticodependent immune-mediated colitis by pembrolizumab, an alternative for patients with concomitant liver injury","volume":"114","year":"2022","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"eabq4006","DOI":"10.1126\/scitranslmed.abq4006","article-title":"Microbiome alteration via fecal microbiota transplantation is effective for refractory immune checkpoint inhibitor-induced colitis","volume":"15","author":"Halsey","year":"2023","journal-title":"Sci. Transl. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1159\/000507579","article-title":"Retrospective Analysis of Treatment and Complications of Immune Checkpoint Inhibitor-Associated Colitis: Histological Ulcerations as Potential Predictor for a Steroid-Refractory Disease Course","volume":"5","author":"Burla","year":"2020","journal-title":"Inflamm. Intest. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2738","DOI":"10.1200\/JCO.19.00320","article-title":"Resumption of Immune Checkpoint Inhibitor Therapy After Immune-Mediated Colitis","volume":"37","author":"Ali","year":"2019","journal-title":"J. Clin. Oncol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/9\/1422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:45:46Z","timestamp":1760111146000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/9\/1422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,30]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["medicina60091422"],"URL":"https:\/\/doi.org\/10.3390\/medicina60091422","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,30]]}}}