Could Less Be More? Reconsidering Immunosuppressive Escalation in Refractory Immune Effector Cell-Associated Enterocolitis Complicated by Recurrent C. difficile Infection (ACG 2026) - Aug 29, 2026 - Abstract #P3667; Pres time: Oct 12, 2026; 10:30 AM - 04:15 PM; Location: Exhibit Halls A - D (Level 3); "Case Description/ A 73-year-old male with multiple myeloma (MM) refractory to several lines of therapy underwent CAR-T infusion with ciltacabtagene autoleucel, developing biopsy-proven disease progression with infiltrative extramedullary disease of the GI tract...difficile PCR returned positive with negative toxin, creating diagnostic uncertainty in the setting of suspected IEC-AE; fidaxomicin was initiated...Diarrhea worsened despite two doses each of cyclophosphamide and vedolizumab...Concurrently, vancomycin was initiated for repeat C. difficile infection and valganciclovir for cytomegalovirus viremia. Ruxolitinib was given for refractory IEC-AE alongside fludarabine for the recurrent and progressive MM involving the GI tract...(A) Upper endoscopy demonstrating diffuse nodular mucosa involving the duodenal bulb and 1st and 2nd portions of the duodenum. (B) Colonoscopy showing grossly normal ascending, transverse, and descending colon despite biopsy-confirmed..."
Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Immunology • Infectious Disease • Inflammatory Bowel Disease • Multiple Myeloma
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Juan P.. De Arrigunaga DO 1; Humberto R.. Nieves-Jiménez MD 2; Mohamad Ali Ibrahim MD 1; Yinghong Wang MD 3
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