Journal
BMC RHEUMATOLOGY
Volume 6, Issue 1, Pages -Publisher
SPRINGERNATURE
DOI: 10.1186/s41927-021-00238-8
Keywords
Mesothelioma; Immunotherapy; Immune related adverse events; Vasculitis; Case report
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This case report presents a rare complication of digital ischemia in a patient with malignant pleural mesothelioma following PD-1 and CTLA-4 blockade therapy. The case highlights the importance of early detection, intervention, and a multispecialty approach in managing such complications.
Background Malignant pleural mesothelioma (MPM) is a rare and aggressive tumour with an overall poor prognosis. In October 2020, first line treatment with the PD-1 antagonist nivolumab and the CTLA-4 antagonist ipilimumab for unresectable disease was FDA approved-the first approved treatment regime since 2004. Interim analyses from the phase 3 CHECKMATE-743 study shows improvements in overall survival. Skin-related toxicities are the most commonly reported any-grade treatment-related adverse event from combined nivolumab and ipilimumab therapy. Case presentation Here we report a case of a 35-year-old white male who developed digital ischaemia secondary to small vessel vasculitis after receiving PD-1 and CTLA-4 blockade therapy for MPM. His progressive ischaemia became gangrenous, and he required multi-speciality input and treatment with prednisolone, prostacyclin, mycophenolate mofetil and hydroxychloroquine. Conclusions Our case highlights the importance of early detection, intervention, and a multispecialty approach to managing such complications in order to minimise the associated morbidity and mortality.
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