Abscess Formation in Metastatic Brain Tumor with History of Immune Checkpoint Inhibitor: A Case Report
Abscess Formation in Metastatic Brain Tumor with History of Immune Checkpoint Inhibitor: A Case Report
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DOI：
10.2176/nmccrj.cr.2018-0126
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发表时间：
2018-12
期刊：
影响因子：
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通讯作者：
Takeshi Takayasu;F. Yamasaki;T. Shishido;M. Takano;H. Maruyama;K. Sugiyama;K. Kurisu
中科院分区：
文献类型：
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作者：
Takeshi Takayasu;F. Yamasaki;T. Shishido;M. Takano;H. Maruyama;K. Sugiyama;K. Kurisu
我们介绍了一名 68 岁男性肺癌脑转移病例，有免疫检查点抑制剂给药史，转移灶内有重叠脓肿。他最初因脑脓肿的诊断而接受了抗生素治疗，因为钆增强壁内的弥散加权成像有一个高强度区域。抗生素治疗后强化病灶大小变化不大，但灶周水肿程度减轻。 2~4个月后，病灶逐渐增大，影像学特征由单囊肿变为多囊肿。手术切除，病理检查显示病变为肺部肿瘤转移。肿瘤内容物涂片检出革兰氏阳性杆菌，证实转移和脑脓肿的双重病理。在讨论发病机制时，我们推测使用 durvalumab (MEDI4736)（一种抗 PD-L1 抗体）治疗会诱导免疫状态改变，包括免疫抑制调节，这可能促进脓肿形成。
We present the case of a 68-year-old man with brain metastasis from lung cancer and a history of immune checkpoint inhibitor administration, with overlapping abscess within the metastatic lesion. He initially received antibiotic treatment under a diagnosis of brain abscess because of a hyper-intense area on diffusion-weighted imaging inside the gadolinium-enhanced wall. The size of the enhanced lesion did not change much, but the extent of perifocal edema decreased after antibiotic treatment. After 2–4 months, the lesion gradually enlarged, and imaging characteristics changed from single cyst to multiple cysts. Surgical resection was performed and pathological examination revealed the lesion as metastasis from the lung tumor. Smear preparation of the tumor contents detected Gram-positive bacilli, confirming the dual pathology of metastasis and brain abscess. Discussing the pathogenesis, we speculated that therapy with durvalumab (MEDI4736), an anti-PD-L1 antibody, induced immune status modification including immunosuppressive regulation, which might have promoted abscess formation.