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Case Report
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| Diarrhea and generalized weakness in a patient with metastatic melanoma and a lumbosacral mass, after initiation of therapy with a checkpoint inhibitor: A case report | ||||||
| Marija Cauchi1, Nikitas Nikitas2 | ||||||
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1MD, Core Medical Trainee 2, Department of the Medicine of the Elderly, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom.
2MD, PhD, Clinical Fellow in Intensive Care Medicine and Neuro-Critical Care, The Neurosciences Critical Care Unit and Major Trauma Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom. | ||||||
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| How to cite this article |
| Cauchi M, Nikitas N. Diarrhea and generalized weakness in a patient with metastatic melanoma and a lumbosacral mass, after initiation of therapy with a checkpoint inhibitor: A case report. Int J Case Rep Images 2015;6(11):682–685. |
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Abstract
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Introduction:
Checkpoint inhibitors are immunomodulatory antibodies against cytotoxic T-lymphocyte-associated antigen [Ipilimumab] and Programmed cell death-1 receptor [nivolumab, pembrolizumab] that have improved the prognosis of patients with melanoma and non-squamous cell lung carcinoma. Despite their clinical benefit, these agents are associated with the development of immune-related adverse events (irAEs) of varying morbidity. These irAEs are clinically challenging to be diagnosed and to be treated, as described in this case report.
Case Report: A 58-year old male presented with radicular pain, weakness and loss of sensation in his right leg, eleven years after treatment for cutaneous melanoma. A large lumbosacral mass found on spinal MRI and patient underwent local palliative radiotherapy and he was initiated on systemic monotherapy with ipilimumab. Two doses of 3 mg/kg ipilimumab were administered intravenously within a 21-day interval. After ipilimumab administration, patient developed subsequently diarrhea and generalized weakness and treatment with corticosteroids initiated. Despite treatment, patient developed type 2 respiratory failure, intubated and admitted in general intensive care unit. Diagnostic workup suggested the presence of both ipilimumab associated severe colitis and Guillain-Barre syndrome (GBS). Ipilimumab was permanently discontinued and patient underwent treatment with infliximab and intravenous immunoglobulin for colitis and Guillain–Barre syndrome respectively. Prolonged recovery followed. Conclusion: To our knowledge, this is the first case report of concomitant development of both ipilimumab-induced severe colitis and life-threatening GBS, in the same patient. The choice of the optimal agent for treatment of these adverse events seems to be system and severity-specific. | |
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Keywords:
Colitis, Guillain-Barre syndrome, Ipilimumab, Melanoma
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Author Contributions
Marija Cauchi – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Nikitas Nikitas – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Marija Cauchi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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