Haemophagocytic lymphohistiocytosis as a complication of combination anti-PD-1 and anti-CTLA-4 checkpoint inhibitor immunotherapy for metastatic melanoma, and the outcome of rechallenge with single-agent anti-PD-1 immunotherapy
- Author(s)
- Holmes, Z; Courtney, A; Hiong, A;
- Details
- Publication Year 2022-08-10,Volume 15,Issue #8,Page e251052
- Journal Title
- BMJ Case Reports
- Publication Type
- Case report
- Abstract
- A woman with metastatic melanoma was treated with immunotherapy induction with ipilimumab and nivolumab and radiotherapy to liver metastases. The patient deteriorated shortly thereafter, becoming febrile and hypotensive and requiring admission to the intensie care unit (ICU) for inotrope support. Failure to respond to antibiotics and a negative septic screen prompted further investigation, which ultimately led to a diagnosis of haemophagocytic lymphohistiocytosis (HLH). The patient improved on high dose steroids and was discharged home. Months later, in the context of progressive melanoma, the patient was re-challenged with nivolumab monotherapy and subsequently experienced recurrence of HLH, confirming the aetiology as being immunotherapy related. This case serves as a reminder to consider HLH where there are fevers of unknown origin in an unwell patient receiving immune checkpoint inhibitor therapy and also highlights immunotherapy as a potential cause for HLH, which has rarely been reported in the literature to date.
- Keywords
- *Antineoplastic Agents, Immunological/adverse effects; Female; Humans; Immune Checkpoint Inhibitors; Immunologic Factors/therapeutic use; Immunotherapy/adverse effects; Ipilimumab/adverse effects; *Lymphohistiocytosis, Hemophagocytic/chemically induced/drug therapy; *Melanoma/pathology; *Neoplasms, Second Primary/drug therapy; Nivolumab/adverse effects; Cancer intervention; Haematology (incl blood transfusion); Skin cancer; Unwanted effects / adverse reactions
- Department(s)
- Medical Oncology
- PubMed ID
- 35948362
- Publisher's Version
- https://doi.org/10.1136/bcr-2022-251052
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-11-08 06:56:17
Last Modified: 2024-11-08 06:56:45