Verma Tushita, Jawadi Altamash, Ahmed Shozab
Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
BMJ Case Rep. 2025 Feb 17;18(2):e262209. doi: 10.1136/bcr-2024-262209.
Immune checkpoint inhibitors (ICIs) block inhibitory pathways that tumour cells exploit to evade the immune system. They play a key role in the management of aggressive cancers, including non-small cell lung cancer, melanoma and Hodgkin's lymphoma. Despite their efficacy, ICIs can cause severe, potentially fatal, immune-related adverse events (irAEs), including multiorgan failure. We present a case of a woman in her early 70s with metastatic lung adenocarcinoma recently initiated on pembrolizumab who presented with an acute stroke complicated by irAE-related multiorgan failure. Despite aggressive treatment, the patient remained critically ill and passed away the same day after transitioning to end-of-life care. This case emphasises the life-threatening potential of irAEs, the importance of early diagnosis and the challenges of managing these complications. Clinicians should maintain a high index of suspicion for irAEs in ICI-treated patients to optimise timely intervention and outcomes.
免疫检查点抑制剂（ICIs）可阻断肿瘤细胞用于逃避免疫系统的抑制性途径。它们在侵袭性癌症的治疗中发挥关键作用，包括非小细胞肺癌、黑色素瘤和霍奇金淋巴瘤。尽管ICIs疗效显著，但可导致严重的、潜在致命的免疫相关不良事件（irAEs），包括多器官功能衰竭。我们报告一例70岁出头的女性，患有转移性肺腺癌，近期开始使用帕博利珠单抗治疗，出现急性中风并伴有irAE相关的多器官功能衰竭。尽管进行了积极治疗，但患者病情仍危重，在转为临终关怀后当天死亡。该病例强调了irAEs的潜在生命威胁、早期诊断的重要性以及管理这些并发症的挑战。临床医生应对接受ICI治疗的患者保持高度的irAEs怀疑指数，以优化及时干预和治疗结果。
