We had an interesting case a few weeks ago with a patient on adjuvant nivolumab. He presented with marked fatigue, nausea, weight loss, hyponatremia and orthostatic hypotension. Therapy was held and we did endocrine labs and a brain MRI looking for hypophysitis which he did not have. We treated him supportively with IVF and frequent visits. It was not until he presented to the ER with chest pain radiating to his back that reflux/gastritis was considered. Endoscopy confirmed esophagitis/gastritis and he is much better on omeprazole and steroids. Have others seen this type of presentation?