Petitdemange A, Béguin L, Dimitrov Y
Service de Néphrologie et Hémodialyse, Centre Hospitalier de Haguenau, Haguenau, France.
Service de Néphrologie et Hémodialyse, Centre Hospitalier de Haguenau, Haguenau, France.
Rev Med Interne. 2023 Jan;44(1):35-37. doi: 10.1016/j.revmed.2022.11.001. Epub 2022 Nov 17.
The occurrence of systemic capillary leak syndrome under immune checkpoint inhibitors has seldom been reported in the literature.
We report two cases of systemic capillary leak syndrome that occurred with nivolumab (anti-PD-1 antibody) for one, and with an anti-PD-1/CTLA-4 bi-specific antibody for the other. Patients presented with anasarca, hypoalbuminemia, acute kidney injury and, in one case, circulatory collapse. Immune checkpoint inhibitor causality was retained in the lack of evidence for other causes of secondary capillary leak syndrome or for an idiopathic form. The symptoms resolved after a few days of supportive measures (associated with glucocorticoids in one case).
A high index of suspicion is required for the diagnosis of immune checkpoint inhibitors-induced systemic capillary leak syndrome because its presentation may differ from that of the idiopathic form. Activated CD8 T-cells play a prominent role in the occurrence of immune checkpoint inhibitors-induced capillary leakage via their cytolytic action on the vascular endothelium. Treatment relies on supportive measures and discontinuation of the immune checkpoint inhibitor while the place of immunomodulatory drugs remains to be defined.
免疫检查点抑制剂引发系统性毛细血管渗漏综合征的情况在文献中鲜有报道。
我们报告了两例系统性毛细血管渗漏综合征病例，一例发生在使用纳武单抗（抗程序性死亡蛋白1抗体）时，另一例发生在使用一种抗程序性死亡蛋白1/细胞毒性T淋巴细胞相关抗原4双特异性抗体时。患者出现全身性水肿、低白蛋白血症、急性肾损伤，其中一例还出现循环衰竭。在缺乏继发性毛细血管渗漏综合征其他病因证据或特发性形式证据的情况下，保留了免疫检查点抑制剂因果关系。经过几天的支持治疗（其中一例联合使用了糖皮质激素）后症状缓解。
对于免疫检查点抑制剂诱导的系统性毛细血管渗漏综合征的诊断，需要高度怀疑指数，因为其表现可能与特发性形式不同。活化的CD8 T细胞通过其对血管内皮的溶细胞作用，在免疫检查点抑制剂诱导的毛细血管渗漏发生中起主要作用。治疗依赖于支持措施和停用免疫检查点抑制剂，而免疫调节药物的作用仍有待确定。
