Furuya Satoshi, Ikemura Shinnosuke, Satoh Tsukasa, Saiki Masafumi, Soejima Kenzo
Department of Respiratory Medicine, Graduate School of Medicine, University of Yamanashi, Chuo, JPN.
Cureus. 2025 Jun 28;17(6):e86935. doi: 10.7759/cureus.86935. eCollection 2025 Jun.
Immune checkpoint inhibitors (ICIs) are associated with a broad spectrum of adverse effects referred to as immune-related adverse events (irAEs). Some infectious diseases can be precipitated by ICIs due to dysregulated inflammatory immune responses referred to as immune reconstitution inflammatory syndrome (IRIS), which were originally described in human immunodeficiency virus (HIV). Here, we report a case of Ramsay Hunt syndrome (RHS) considered to have occurred as "non-HIV IRIS" after the administration of pembrolizumab. A 64-year-old man with stage IVb lung adenocarcinoma was treated with pembrolizumab as first-line chemotherapy. He presented with a headache in two days and right facial paralysis with some vesicles on the rash in the right external auditory canal six days after the administration. We diagnosed ICI-induced RHS and initiated valacyclovir and systemic corticosteroid therapy. The degree of facial paralysis was severe, but it recovered gradually. Although ICI rarely causes RHS, clinicians should be aware of the possibility of RHS, as the prognosis of paralysis depends on early treatment.
免疫检查点抑制剂（ICI）与一系列被称为免疫相关不良事件（irAE）的不良反应有关。一些传染病可能由ICI诱发，这是由于炎症免疫反应失调，即免疫重建炎症综合征（IRIS），最初是在人类免疫缺陷病毒（HIV）感染中描述的。在此，我们报告一例在使用帕博利珠单抗后被认为是作为“非HIV-IRIS”发生的拉姆齐·亨特综合征（RHS）病例。一名64岁的IVb期肺腺癌男性患者接受帕博利珠单抗作为一线化疗。用药两天后出现头痛，用药六天后出现右侧面部麻痹，右侧外耳道皮疹处有一些水疱。我们诊断为ICI诱发的RHS，并开始使用伐昔洛韦和全身性糖皮质激素治疗。面部麻痹程度严重，但逐渐恢复。尽管ICI很少引起RHS，但临床医生应意识到RHS的可能性，因为麻痹的预后取决于早期治疗。
