Ota Hiroaki, Munechika Miyuki, Tobino Kazunori, Uchida Kazuki, Muarakami Yosuke
Respiratory Medicine, Iizuka Hospital, Iizuka, JPN.
Cureus. 2024 Apr 14;16(4):e58253. doi: 10.7759/cureus.58253. eCollection 2024 Apr.
Immune checkpoint inhibitors (ICIs) are used to treat a variety of tumors. Despite their broad beneficial effects, these inhibitors can cause immune-related adverse events (irAEs) and even death. Hemophagocytic lymphohistiocytosis (HLH) and meningitis, although infrequent, can be aggressive and life-threatening due to excessive immune activation. Herein, we report a case of an 80-year-old man who developed HLH after receiving atezolizumab monotherapy as a second-line treatment for lung adenocarcinoma. He was treated for HLH with oral prednisolone (PSL), but further ataxia and dysuria developed, and a lumbar puncture diagnosed meningitis. Both HLH and meningitis improved with continued oral PSL treatment. This is the first case of atezolizumab-induced HLH with meningitis and highlights the importance of early diagnosis and treatment for rare irAE.
免疫检查点抑制剂（ICIs）用于治疗多种肿瘤。尽管这些抑制剂具有广泛的有益作用，但它们可导致免疫相关不良事件（irAEs）甚至死亡。噬血细胞性淋巴组织细胞增生症（HLH）和脑膜炎虽然不常见，但由于过度免疫激活可能具有侵袭性并危及生命。在此，我们报告一例80岁男性病例，该患者在接受阿替利珠单抗单药治疗作为肺腺癌二线治疗后发生了HLH。他接受了口服泼尼松龙（PSL）治疗HLH，但随后出现了共济失调和排尿困难，腰椎穿刺诊断为脑膜炎。持续口服PSL治疗后，HLH和脑膜炎均得到改善。这是首例阿替利珠单抗诱导的HLH合并脑膜炎病例，强调了对罕见irAE进行早期诊断和治疗的重要性。
