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Streptococcal Pharyngitis — USMLE Step 2 CK MCQ

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HardInfectious DiseasesStreptococcal PharyngitisUSMLE Step 2 CK

A patient receiving pembrolizumab develops eight bloody stools daily, abdominal pain and dehydration. Stool pathogen testing is negative, CT shows diffuse colitis without perforation and colonoscopy confirms immune-mediated colitis. Which treatment is most appropriate now?

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Correct answer: A — Hold pembrolizumab and begin high-dose intravenous glucocorticoids

Eight bloody stools daily with dehydration and confirmed immune-mediated colitis is grade 3 toxicity: pembrolizumab should be held and high-dose intravenous glucocorticoids started. Continuing pembrolizumab permits further immune injury. Oral prednisone is less appropriate than intravenous therapy in this hospitalized dehydrated patient. Infliximab or vedolizumab is added for glucocorticoid-refractory disease or selected contraindications, not used before the initial glucocorticoid trial.

Reference: ASCO guideline update for immune-related adverse events: https://doi.org/10.1200/JCO.21.01440