Department of Respiratory Medicine, Okayama University Hospital, Japan.
Center for Clinical Oncology, Okayama University Hospital, Japan.
Intern Med. 2024 May 1;63(9):1261-1267. doi: 10.2169/internalmedicine.2429-23. Epub 2023 Sep 15.
A 55-year-old man with stage IV lung adenocarcinoma was treated with cisplatin, pemetrexed, nivolumab, and ipilimumab. Approximately 100 days after treatment initiation, he became disoriented and presented to the emergency department with a high fever. Blood tests revealed liver and kidney dysfunctions. Subsequently, the patient developed generalized convulsions that required intensive care. He was clinically diagnosed with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Organ damage was gradually controlled with immunosuppressive drugs, including steroids, and the patient was discharged. Successful treatment is rare in patients with CRS, including ICANS, during immune checkpoint inhibitor treatment for solid tumors.
一位 55 岁的 IV 期肺腺癌男性患者接受了顺铂、培美曲塞、纳武利尤单抗和伊匹单抗治疗。治疗开始后约 100 天,他出现了定向障碍,并因高热到急诊就诊。血液检查显示肝肾功能异常。随后,患者出现全身抽搐,需要重症监护。临床诊断为细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征(ICANS)。通过免疫抑制剂治疗(包括类固醇)逐渐控制器官损伤,患者出院。在免疫检查点抑制剂治疗实体瘤期间,出现 CRS 包括 ICANS 的患者,其 CRS 治疗成功率较低。
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