Department of Dermatology and Allergy, University Hospital.
Department of Otorhinolaryngology, Head and Neck Surgery, Großhadern Medical Center, Ludwig-Maximilians University, Munich.
J Immunother. 2021 Jun 1;44(5):193-197. doi: 10.1097/CJI.0000000000000367.
Immune-related adverse events have been described in 86%-96% of high-risk melanoma patients treated with immune checkpoint inhibitors (ICI), while in 17%-59% of cases these are classified as severe or even life-threatening. The most common immune-related adverse events include diarrhea, fatigue, hypothyroidism, and hepatitis. Bilateral uveitis and unspecific vertigo have been described in 1% of cases, respectively, in the pivotal studies of ICIs, but the affection of the vestibule-cochlear system has not been reported before. In this case series, we present 3-stage IV melanoma patients with sudden onset of otovestibular dysfunction (hearing loss and vestibulopathy), partly combined with uveitis because of ICIs. We describe detailed diagnostic work-up and therapeutic interventions and discuss possible pathogenic mechanisms of this rare and disabling event.
免疫相关不良反应在接受免疫检查点抑制剂 (ICI) 治疗的高危黑色素瘤患者中已有 86%-96%的描述，而在 17%-59%的病例中这些不良反应被归类为严重甚至危及生命。最常见的免疫相关不良反应包括腹泻、疲劳、甲状腺功能减退和肝炎。在 ICI 的关键研究中，分别有 1%的病例出现双侧葡萄膜炎和非特异性眩晕，但前庭耳蜗系统的受累以前没有报道过。在本病例系列中，我们报告了 3 例 IV 期黑色素瘤患者，由于 ICI 导致突发性耳前庭功能障碍（听力损失和前庭病），部分伴有葡萄膜炎。我们描述了详细的诊断方法和治疗干预措施，并讨论了这种罕见且致残事件的可能发病机制。
