Pierrard Julien, Petit Bénédicte, Lejeune Sarah, Seront Emmanuel
Medical Oncology, Hopital de Jolimont, Haine-Saint-Paul, Belgium.
BMJ Case Rep. 2019 Aug 21;12(8):e230848. doi: 10.1136/bcr-2019-230848.
The increased use of immune checkpoint inhibitors (ICIs) has led to the observation of a variety of immune-related adverse events (irAEs). These irAEs occur usually within the first months after ICIs onset and can involve theorically all organs. We describe two rare irAEs occurring in a 70-year-old caucasian man who was treated with nivolumab for an advanced urothelial cancer of the left kidney. He developed an isolated adrenocorticotropic hormone deficiency that was diagnosed at week 19 and a neurological complication that appeared at week 79 and initially confounded with a lumbar spinal stenosis. Diagnosis of Guillain-Barré syndrome was finally confirmed with the complete resolution of symptoms after 5 days of intravenous immunoglobulin and corticosteroids. We highlight the importance of quickly recognising these potential life-threatening irAEs such as cortisol insufficiency and neurologic adverse events whose initially presentation could be non-specific.
免疫检查点抑制剂（ICIs）使用的增加导致了各种免疫相关不良事件（irAEs）的出现。这些irAEs通常发生在开始使用ICIs后的最初几个月内，理论上可累及所有器官。我们描述了一名70岁白种男性发生的两种罕见irAEs，该患者因左肾晚期尿路上皮癌接受纳武单抗治疗。他出现了孤立性促肾上腺皮质激素缺乏，于第19周被诊断出来，还出现了一种神经并发症，在第79周出现，最初被误诊为腰椎管狭窄。在静脉注射免疫球蛋白和使用皮质类固醇5天后症状完全缓解，最终确诊为吉兰 - 巴雷综合征。我们强调了快速识别这些潜在危及生命的irAEs的重要性，例如皮质醇不足和神经不良事件，其最初表现可能不具有特异性。
