Resolution of ipilimumab induced severe hepatotoxicity with triple immunosuppressants therapy.
Resolution of ipilimumab induced severe hepatotoxicity with triple immunosuppressants therapy.
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DOI：
10.1136/bcr-2014-208102
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发表时间：
2015-07-14
期刊：
影响因子：
0.9
通讯作者：
Black, Jason
中科院分区：
文献类型：
--
作者：
Ahmed, Tauqeer;Pandey, Ritwik;Black, Jason
我们描述了一名来自澳大利亚远北昆士兰州的患者，该患者因伊匹单抗诱导的免疫相关不良事件 (irAE) 导致危及生命的肝毒性。我们的患者出现非特异性症状，包括不适、嗜睡和发烧。她的检查显示患有急性肝炎，推测这与伊匹单抗治疗她的转移性黑色素瘤有关。使用 CIOMS 量表（国际医学科学组织理事会）评估易普利姆玛的因果关系，并提供“极有可能”的因果关系级别（得分 +9）。根据伊匹单抗诱导的 irAE 指南，她开始服用甲基强的松龙。治疗第二天，她的转氨酶意外上升了数百倍。对急性肝炎的其他原因（包括腹部影像学）的调查结果呈阴性。她首先服用马抗胸腺细胞球蛋白霉酚酸酯，然后继续服用甲基泼尼松龙。她的临床和生化指标在两周内康复，并继续保持良好状态。
We describe a case of a patient from Far North Queensland, Australia, with life-threatening hepatotoxicity caused by ipilimumab induced immune-related adverse events (irAEs). Our patient presented with non-specific symptoms including malaise, lethargy and fevers. Her work up revealed acute hepatitis, which was presumed to be related to ipilimumab treatment for her metastatic melanoma. Causality for ipilimumab was assessed with the CIOMS scale (Council for International Organizations of Medical Sciences) and provided a causality level of 'highly probable' (score +9). She was started on methylprednisolone as per guidelines for ipilimumab induced irAEs. On the second day of treatment her transaminases enzymes unexpectedly rose several hundred times. Investigations for other causes of acute hepatitis including abdominal imaging were negative. She was started up front on equine antithymocyte globulin, mycophenolate moefetil and continued on methylprednisolone. She recovered clinically and biochemically in 2 weeks and continues to remain well.