Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan.
Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Medicine, Asahikawa Medical University, Japan.
Intern Med. 2022 Dec 1;61(23):3497-3502. doi: 10.2169/internalmedicine.9393-22. Epub 2022 Apr 30.
A 63-year-old man with hepatitis C was treated with atezolizumab plus bevacizumab for unresectable diffuse hepatocellular carcinoma (HCC). After four cycles of atezolizumab plus bevacizumab, the diffuse HCC markedly shrank; however, he complained of general fatigue, loss of appetite, and slight loss of muscle strength in the lower legs. He was diagnosed with isolated adrenocorticotropic hormone deficiency (IAD), hypothyroidism, and myopathy, suggesting multisystem immune-related adverse events (irAEs). After administration of hydrocortisone, the clinical symptoms rapidly disappeared. Patients with multisystem irAEs can have favorable outcomes; thus, to continue immune-checkpoint inhibitors therapy, a correct diagnosis and management of multisystem irAEs are important.
一位 63 岁的丙型肝炎患者因不可切除的弥漫性肝细胞癌（HCC）接受阿替利珠单抗联合贝伐珠单抗治疗。在接受阿替利珠单抗联合贝伐珠单抗四个周期后，弥漫性 HCC 明显缩小；然而，他主诉全身乏力、食欲不振和小腿轻度肌肉无力。他被诊断为孤立性促肾上腺皮质激素缺乏症（IAD）、甲状腺功能减退症和肌病，提示多系统免疫相关不良事件（irAEs）。给予氢化可的松后，临床症状迅速消失。多系统 irAEs 的患者可能有良好的结局；因此，为了继续免疫检查点抑制剂治疗，正确诊断和管理多系统 irAEs 很重要。
