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. 2020 Jun 24;8(1):e000958. doi: 10.1136/jitc-2020-000958

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See https://creativecommons.org/licenses/by/4.0/.

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In a patient with immune checkpoint inhibitor (ICI)-associated duodenitis, an endoscopic image of the duodenum reveals diffuse inflammation characterized by congestion, erosions, erythema, and granularity (A). On biopsy, routine H&E showed a markedly active neutrophilic duodenitis with mild-to-moderate villous blunting, marked expansion of the lamina propria, and only mildly increased intraepithelial lymphocytes (B, C). A patient with ICI-celiac disease (CeD) showed endoscopic findings of diffuse inflammation characterized by congestion, erythema, and friability (D). Biopsy of the duodenum showed a mildly active neutrophilic duodenitis with marked villous blunting and increased intraepithelial lymphocytes (E). Intraepithelial lymphocytosis, however, was not present in all ICI-CeD biopsies (F).