Roberge-Maltais Eugénie, Lévesque Eric, Castonguay Vincent, Marcoux Nicolas, Grenier Louis-Philippe, Veilleux Martin
Department of Internal Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada.
Department of Hemato-Oncology, CHU de Quebec, Université Laval, Quebec City, QC G1V 4G2, Canada.
Curr Oncol. 2025 Aug 18;32(8):469. doi: 10.3390/curroncol32080469.
Systemic Capillary Leak Syndrome (SCLS) and Cytokine Release Syndrome (CRS) have both been described as rare but severe adverse reactions induced by Programmed cell death protein 1 (PD-1) inhibitors such as pembrolizumab. We report the case of a 40-year-old woman undergoing treatment with pembrolizumab for a stage 4 cervical squamous cell carcinoma who presented with anasarca, hypotension, hemoconcentration and signs of multisystemic inflammation. After elimination of alternative causes such as nephrotic syndrome, cardiac dysfunction and cirrhosis, she was diagnosed with both pembrolizumab-induced SCLS and CRS. She was successfully treated with a multimodal treatment approach including intravenous immunoglobulins, steroids, diuretics and axitinib for SCLS as well as ruxolitinib for CRS. After several months of hospitalization, her symptoms finally improved with this treatment regimen, and she was able to attain euvolemic state and be discharged from the hospital. This case highlights certain rare and severe adverse effects of treatment with PD-1 inhibitors. Furthermore, it proposes a novel therapeutic approach for similar cases based upon probable underlying physiopathological mechanisms in SCLS and CRS.
系统性毛细血管渗漏综合征（SCLS）和细胞因子释放综合征（CRS）均被描述为帕博利珠单抗等程序性细胞死亡蛋白1（PD-1）抑制剂引起的罕见但严重的不良反应。我们报告了一例40岁女性，她因IV期宫颈鳞状细胞癌接受帕博利珠单抗治疗，出现全身性水肿、低血压、血液浓缩和多系统炎症体征。在排除肾病综合征、心脏功能障碍和肝硬化等其他病因后，她被诊断为帕博利珠单抗诱导的SCLS和CRS。她通过多模式治疗方法成功治愈，该方法包括静脉注射免疫球蛋白、类固醇、利尿剂和阿昔替尼治疗SCLS，以及芦可替尼治疗CRS。经过数月住院治疗，她的症状最终通过该治疗方案得到改善，能够达到血容量正常状态并出院。该病例突出了PD-1抑制剂治疗的某些罕见且严重的不良反应。此外，它基于SCLS和CRS可能的潜在生理病理机制，为类似病例提出了一种新的治疗方法。
