A patient suffering from various immune-related adverse events following treatment with ipilimumab

J. Rutgers, D. Piersma

Voorzitter(s): prof. dr. J.W. de Fijter, LUMC, Leiden & dr. W.G. Meijer, WestFries Gasthuis, Hoorn

Woensdag 22 april 2015

15:00 - 16:00u in Auditorium 1

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 1: Case reports/research

A 55-year-old man was referred to the emergency department with complaints of severe headache, nausea and vertigo since five days and a short episode of diplopia. He was suffering from a melanoma with metastasis to the lymph nodes, liver and lung for which he was treated with ipilimumab, an immunotherapeutic agent. Physical examination revealed a hemodynamically stable man with normal results of heart, lungs and abdomen. Neurological examination revealed no abnormalities either. Laboratory findings demonstrated slight leucocytosis of 14.9x109/L with eosinophils 0.9x109/L and CRP 12mg/L. ESR, hemoglobin, platelets, renal and hepatic function were normal. Initially, cerebral metastasis was considered to be the cause of his complaints. An MRI was performed two days later, showing pituitary enlargement. Extensive laboratory investigations revealed severe hypopituitarism with low levels of TSH, FT4, testosterone and gonadotropins and normal ACTH with low cortisol, caused by hypophysitis, one of the immune-related adverse events of ipilimumab. Immediate treatment with high-dose corticosteroids and hormone replacement was started and the patient’s symptoms resolved rapidly. Subsequently he developed two other autoimmune-related toxicities, i.e. diarrhoea caused by colitis for which he needed infliximab and peroneus neuropathy. Eventually these events were well controlled. Even though response evaluation showed progressive disease, the patient is still alive today. This case report illustrates that patients treated with ipilimumab can present with various symptoms that may be based on serious, potentially life-threatening immune-related adverse events that can occur in virtually all organs and require urgent treatment. Vigilance is therefore warranted when patients taking ipilimumab report complaints.

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