Chris O'Brien Lifehouse, Medical Oncology Department, Camperdown, NSW, Australia.
Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Immunotherapy. 2018 Mar;10(3):171-175. doi: 10.2217/imt-2017-0126.
We report a case of isolated immune-related pancreatic exocrine insufficiency in a patient treated with pembrolizumab for metastatic melanoma. This patient presented with explosive diarrhea and was treated with high dose corticosteroids for possible immune-related colitis. However, biopsies from colon and duodenum did not show any histological evidence of colitis/enteritis. Serum amylase and lipase were not elevated. There was no evidence of pancreatitis or pancreatic metastases on imaging. Significantly lower fecal elastase test on two occasions confirmed the diagnosis of pancreatic exocrine insufficiency. He was treated with pancreatic enzyme supplementation with complete resolution of diarrhea. This case reinforces the importance of awareness and anticipation of unusual immune-related adverse events related to checkpoint inhibitors.
我们报告了一例接受派姆单抗治疗转移性黑色素瘤的患者发生孤立性免疫相关胰腺外分泌功能不全。该患者出现暴发性腹泻，并接受大剂量皮质类固醇治疗可能的免疫相关结肠炎。然而，结肠和十二指肠的活检没有显示出任何结肠炎/肠炎的组织学证据。血清淀粉酶和脂肪酶没有升高。影像学检查没有胰腺炎或胰腺转移的证据。两次粪便弹性蛋白酶检测明显降低，证实了胰腺外分泌功能不全的诊断。他接受了胰腺酶补充治疗，腹泻完全缓解。本病例强调了对检查点抑制剂相关不常见免疫相关不良反应的认识和预期的重要性。
