A label that fits too easily
Educational use only. Not clinically reviewed63-year-old man for exclusion recording, open-question recording, parallel escalation, evidence-boundary review, and handoff practice. About 8 simulated minutes.
What you will practise
- Record that the label is a diagnosis of exclusion.
- Record what has not been excluded.
- Escalate so the samples and the treatment decision start together.
- Refuse immunosuppression before exclusion, for the specific reason.
- Record bounded qualified-team treatment intent.
- Review two boundaries that pull against each other.
- Hand off the open question rather than a settled label.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Li H, Fu ZY, Arslan ME, Cho D, Lee H. Differential diagnosis and management of immune checkpoint inhibitor-induced colitis: a comprehensive review. World J Exp Med. 2021;11(6):79-92. "The diagnosis of ICI-induced colitis is one of exclusion and requires exclusion of other competing etiologies", including cytomegalovirus and Clostridioides difficile, whose clinical presentation is described as indistinguishable from that of ICI-induced colitis. "microbiological studies and/or stool culture should be performed first to exclude the common infectious etiologies" before immunosuppressive therapy, and ICI-induced colitis patients are at increased risk for infectious colitis. "current guidelines universally recommend corticosteroids as initial management for ICI-induced colitis that is grade 2 or of higher grade".
- Dougan M, Wang Y, Rubio-Tapia A, Lim JK. AGA clinical practice update on diagnosis and management of immune checkpoint inhibitor colitis and hepatitis: expert review. Gastroenterology. 2021;160(4):1384-1393. An expert review providing best practice advice on the diagnosis and management of the gastrointestinal and hepatic toxicities of immune checkpoint inhibitors, cited here as the existence of a formal practice statement on this problem rather than for any figure.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.