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由纳武利尤单抗引起的危及生命的继发性硬化性胆管炎病例。

A case with life-threatening secondary sclerosing cholangitis caused by nivolumab.

机构信息

Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.

Research Center for Hepatology and Gastroenterology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

出版信息

Clin J Gastroenterol. 2021 Feb;14(1):283-287. doi: 10.1007/s12328-020-01287-1. Epub 2020 Nov 16.

Abstract

Immune checkpoint inhibitor (ICI) therapy has potent anti-cancer effects but is associated with immune-related adverse events (irAEs). We present a case who developed secondary sclerosing cholangitis following treatment with nivolumab for non-small cell lung cancer who did not respond to immunosuppressive treatments and died of liver failure. A 75 year-old male with lung cancer who had been treated with nivolumab for non-small cell lung cancer developed Grade 3 liver injury with significant elevation of hepatobiliary enzymes. Magnetic resonance cholangiopancreatography (MRCP) revealed diffuse dilatation of the common bile duct and multifocal stenosis with prestenotic dilatation from the perihilar to intrahepatic bile duct, consistent with sclerosing cholangitis. Histological findings represented an infiltration of mainly CD8-positive T cells around the bile ducts in the liver. Despite treatments with ursodeoxycholic acid, prednisolone, and mycophenolate mofetil, the sclerosing cholangitis did not improve, and the patient died due to liver failure and aggravation of lung cancer. These findings suggest that immune checkpoint inhibitors may lead to resistance to immunosuppressive treatment as well as pose a risk of life-threatening sclerosing cholangitis.

摘要

免疫检查点抑制剂 (ICI) 治疗具有强大的抗癌作用,但与免疫相关的不良反应 (irAE) 有关。我们报告了一例非小细胞肺癌患者接受纳武利尤单抗治疗后发生继发性硬化性胆管炎的病例,该患者对免疫抑制治疗无反应,并因肝功能衰竭而死亡。一名 75 岁男性,患有肺癌,曾接受纳武利尤单抗治疗非小细胞肺癌,发生 3 级肝损伤,肝酶显著升高。磁共振胰胆管成像 (MRCP) 显示胆总管弥漫性扩张,肝内胆管从肝门周围到肝内多灶性狭窄伴狭窄前扩张,符合硬化性胆管炎。组织学发现主要为 CD8 阳性 T 细胞浸润在肝脏胆管周围。尽管接受了熊去氧胆酸、泼尼松龙和霉酚酸酯治疗,但硬化性胆管炎并未改善,患者因肝功能衰竭和肺癌恶化而死亡。这些发现表明,免疫检查点抑制剂可能导致对免疫抑制治疗的耐药性,并带来危及生命的硬化性胆管炎的风险。

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