Yaşar Hatime A, Akkus Erman, Heper Aylin, Akay Bengu N, Urun Yuksel, Utkan Gungor
Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey.
Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey.
J Oncol Pharm Pract. 2020 Oct;26(7):1762-1764. doi: 10.1177/1078155220906885. Epub 2020 Feb 23.
Ipilimumab is an anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) antibody. Ipilimumab has shown improvement in overall survival in patients with advanced melanoma. Because ipilimumab activates the immune system against the tumor, ipilimumab is associated with adverse events related to immune system activation. Immune-associated side effects are frequently seen in the gastrointestinal system and skin. Sweet's syndrome (SS) is an uncommon inflammatory disorder. Some drugs or malignancy can cause SS. Only a few case reports have been reported of ipilimumab-associated SS.
A 53-year-old female with metastatic melanoma was treated with ipilimumab. After the fourth cycle, she developed painful lesions on her legs and hands. The pathologic biopsy of the lesions revealed neutrophilic dermatosis consistent with SS. The patient was treated with 60 mg/day of prednisone for four days, nonsteroidal anti-inflammatory drugs and inhaler bronchodilator and steroid. She had symptomatic relief at the beginning of treatment. The prednisone doses were quickly tapered every three days. When the patient was treated with 10 mg/day of prednisone for three days, the skin nodules recurred. Prednisone 40 mg per day was re-started and then a slower taper by decreasing by 10 mg/day every week was instituted. After one-month treatment the prednisone dose was given as a 5 mg doses for one week and then stopped. No new lesions recurred after slower taper of prednisone.
Herein we report a case presented with SS under ipilimumab therapy. Melanoma patients treated with ipilimumab can develop SS. The clinicians should be aware of this condition.
伊匹单抗是一种抗细胞毒性T淋巴细胞抗原4（CTLA-4）抗体。伊匹单抗已显示可改善晚期黑色素瘤患者的总生存期。由于伊匹单抗激活免疫系统对抗肿瘤，因此它与免疫系统激活相关的不良事件有关。免疫相关的副作用在胃肠道系统和皮肤中很常见。Sweet综合征（SS）是一种罕见的炎症性疾病。某些药物或恶性肿瘤可导致SS。仅有少数关于伊匹单抗相关SS的病例报告。
一名53岁的转移性黑色素瘤女性患者接受了伊匹单抗治疗。在第四个疗程后，她的腿部和手部出现疼痛性病变。病变的病理活检显示符合SS的嗜中性皮病。患者接受了为期四天的每日60毫克泼尼松治疗，以及非甾体抗炎药、吸入性支气管扩张剂和类固醇治疗。治疗开始时她的症状有所缓解。泼尼松剂量每三天迅速递减。当患者接受为期三天的每日10毫克泼尼松治疗时，皮肤结节复发。重新开始每日40毫克泼尼松治疗，然后每周递减10毫克，逐渐缓慢减量。经过一个月的治疗，泼尼松剂量减至每日5毫克，持续一周，然后停药。在泼尼松缓慢减量后未出现新的病变。
在此我们报告一例在伊匹单抗治疗下出现SS的病例。接受伊匹单抗治疗的黑色素瘤患者可能会发生SS。临床医生应意识到这种情况。
