Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 950-8510, Japan.
Eur Arch Otorhinolaryngol. 2024 Apr;281(4):2037-2040. doi: 10.1007/s00405-024-08495-2. Epub 2024 Feb 3.
Immune-related adverse events (irAEs) due to immune checkpoint inhibitors may lead to discontinuation and treatment-related death. Acute aortitis is a rare but severe irAE.
A 67-year-old man with recurrent lower gingival carcinoma received nivolumab therapy. Twenty-three months later, he experienced chest compression, which resulted in syncope. Following a whole-body computed tomography (CT) scanning, which revealed diffuse thickening of the aorta, and systemic assessments of the causes of aortitis, he was diagnosed with acute aortitis due to irAE. Nivolumab discontinuation and oral steroids improved CT findings. However, 11 months after nivolumab discontinuation, he developed an aortic aneurysmal rupture. Endovascular aortic repair rescued him. A durable anti-cancer response was still observed 4 months after the aortic rupture.
Although severe irAE, such as acute aortitis, occurred, the patient may still achieve a durable response. A broad examination and prompt treatment of irAE can help improve the patient's survival.
免疫检查点抑制剂引起的免疫相关不良反应（irAEs）可能导致停药和治疗相关死亡。急性主动脉炎是一种罕见但严重的 irAE。
一名 67 岁男性，患有复发性下牙龈癌，接受了nivolumab 治疗。23 个月后，他出现胸痛，导致晕厥。全身 CT 扫描显示主动脉弥漫性增厚，系统性评估主动脉炎的病因后，他被诊断为免疫检查点抑制剂引起的急性主动脉炎。停用 nivolumab 和口服类固醇改善了 CT 发现。然而，在停用 nivolumab 11 个月后，他发生了主动脉瘤破裂。血管内主动脉修复挽救了他。主动脉破裂后 4 个月仍观察到持久的抗肿瘤反应。
尽管发生了严重的 irAE，如急性主动脉炎，但患者仍可能获得持久的反应。广泛的 irAE 检查和及时治疗有助于提高患者的生存率。
