Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Division of Hematology and Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
J Immunother Cancer. 2021 Jul;9(7). doi: 10.1136/jitc-2021-002855.
Cytokine release syndrome (CRS) is a well-described immune-related adverse event following chimeric antigen receptor T-cell therapy, but has rarely been reported following anti-programmed death ligand-1 therapy. We report the case of a 55-year-old man with metastatic lung adenocarcinoma who presented with fever, chills and hypotension. Initial labs were notable for highly elevated serum ferritin levels and mildly elevated triglyceride levels. He was ultimately diagnosed with pembrolizumab-induced CRS complicated by multiorgan failure. The patient was treated with steroids and tocilizumab with normalization of inflammatory markers and resolution of renal failure. This case not only highlights the importance of considering CRS in patients who have developed multiorgan failure after immune checkpoint inhibitor therapy, but also demonstrates clinical similarities between CRS and other hyperinflammatory states such as hemophagocytic lymphohistiocytosis.
细胞因子释放综合征（CRS）是嵌合抗原受体 T 细胞治疗后一种描述明确的免疫相关不良反应，但在抗程序性死亡配体-1 治疗后很少有报道。我们报告了一例 55 岁男性，患有转移性肺腺癌，表现为发热、寒战和低血压。初始实验室检查显示血清铁蛋白水平显著升高，甘油三酯水平轻度升高。最终诊断为 pembrolizumab 诱导的 CRS 合并多器官衰竭。该患者接受了类固醇和托珠单抗治疗，炎症标志物正常化，肾功能衰竭得到缓解。本病例不仅强调了在免疫检查点抑制剂治疗后发生多器官衰竭的患者中考虑 CRS 的重要性，还表明 CRS 与噬血细胞性淋巴组织细胞增生症等其他炎症反应状态之间存在临床相似性。
