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Anorexia, vomiting and weight loss in a 22-year-old woman
  1. Vincent Ting Fung Cheung1,
  2. Eve Fryer2,
  3. Miranda J Payne3,
  4. Oliver Brain1
  1. 1 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
  2. 2 Department of Histopathology, John Radcliffe Hospital, Oxford, UK
  3. 3 Department of Oncology, Churchill Hospital, Oxford, UK
  1. Correspondence to Dr Vincent Ting Fung Cheung, Department of Gastroenterology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK; vincent.cheung{at}doctors.org.uk

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Clinical presentation

A 22-year-old woman presented in December 2017 with a 2-month history of postprandial abdominal pain, nausea, vomiting, early satiety and 4 kg weight loss. She had entirely normal bowel habit. She did not use non-steroidal anti-inflammatory drugs and omeprazole had not helped her symptoms. Her medical history included resection of 1.8 mm Spitz melanoma in June 2010 and left axillary dissection in November 2012 (3/22 nodes positive). She received first-line ipilimumab and nivolumab starting November 2016. Cycle 2 was complicated by grade 2 hepatotoxicity that resolved spontaneously; cycle 4 by grade 3 hepatotoxicity requiring steroids and mycophenolate mofetil (discontinued in August 2017). She had stereotactic radiosurgery for a right temporal lobe metastasis in June 2017 and restarted on maintenance nivolumab monotherapy in July 2017. In December …

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