Yasuda Hiromi, Ichikawa Takashi, Yoshiyama Shigeyuki, Ohi Masaki, Toiyama Yuji
Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Graduate School of Medicine, Mie University, Tsu, JPN.
Cureus. 2025 Aug 4;17(8):e89366. doi: 10.7759/cureus.89366. eCollection 2025 Aug.
Conversion surgery is increasingly used for initially unresectable esophageal cancer patients responding to induction therapy. The integration of immune checkpoint inhibitors (ICIs) into standard chemotherapy regimens is expected to increase the number of patients undergoing this approach. However, ICIs can cause immune-related adverse events (irAEs), which are often difficult to diagnose in the postoperative setting. Among these, drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially life-threatening complication. A 71-year-old woman with stage IVA esophageal squamous cell carcinoma received induction chemotherapy, including nivolumab, fluorouracil, and cisplatin, followed by successful conversion surgery. Postoperatively, she developed fever, widespread rash, eosinophilia, and liver dysfunction. Initial suspicion was sepsis, and broad-spectrum antibiotics were started. However, repeated tests showed no infection. The retrospective review met the criteria for DRESS syndrome, with the postoperative contrast agent likely triggering the reaction. Supportive care and discontinuation of unnecessary antibiotics led to gradual improvement, and she was discharged for rehabilitation. This case highlights the diagnostic challenge of hypersensitivity reactions such as DRESS in the postoperative setting after ICI-based therapy. Although not a classical irAE, ICI-induced immune dysregulation may have contributed to its development. Awareness of atypical irAEs is essential for timely diagnosis and appropriate management.
转化手术越来越多地用于对诱导治疗有反应的初始不可切除食管癌患者。将免疫检查点抑制剂（ICI）纳入标准化疗方案有望增加接受这种治疗方法的患者数量。然而，ICI可引起免疫相关不良事件（irAE），在术后环境中往往难以诊断。其中，药物性嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种罕见但可能危及生命的并发症。一名71岁的IV A期食管鳞状细胞癌女性接受了诱导化疗，包括纳武单抗、氟尿嘧啶和顺铂，随后成功进行了转化手术。术后，她出现发热、广泛皮疹、嗜酸性粒细胞增多和肝功能障碍。最初怀疑是败血症，于是开始使用广谱抗生素。然而，反复检查未发现感染。回顾性评估符合DRESS综合征的标准，术后造影剂可能引发了该反应。支持性治疗和停用不必要的抗生素导致病情逐渐好转，她出院进行康复治疗。该病例凸显了基于ICI治疗后术后环境中如DRESS等超敏反应的诊断挑战。尽管不是典型的irAE，但ICI诱导的免疫失调可能促成了其发生。认识非典型irAE对于及时诊断和适当管理至关重要。
