ABSTRACT
BACKGROUND: Immune checkpoint inhibitors (anti-PD1 or anti-CTLA-4) are increasingly used in various cancers. Immune checkpoint inhibitors (ICI)-related renal disorders are poorly described (9 cases) and were only related to Ipilimumab. METHODS: Retrospective collection of clinical charts of all the patients admitted for renal disorders following ICI in the University Hospital of Toulouse (France). RESULTS: We report on adverse renal events that occurred in three patients treated with anti-PD1 (nivolumab or pembrolizumab) or anti-CTLA-4 (ipilimumab). Acute kidney injury occurred at 4-12 weeks after initiation of treatment, and harbored features of tubulo-interstitial nephritis (interstitial polymorphic inflammatory infiltrate with predominant CD3+ CD4+ T cells, associated with granuloma in one). Following withdrawal of ICI and steroid intake, estimated glomerular-filtration rate had improved in all patients. CONCLUSIONS: These data suggest that all ICI can lead to acute interstitial nephritis, possibly related to the presence of autoreactive clonal T cells. We recommend that patients receiving ICI should undergo renal monitoring every 2 weeks for 3-6 months.
Subject(s)
Antibodies, Monoclonal/adverse effects , Cell Cycle Checkpoints , Nephritis, Interstitial/immunology , Aged , Female , Humans , Ipilimumab , Middle Aged , Retrospective StudiesABSTRACT
We describe 2 patients with spinal cord compression that occurred in the course of biopsy-proven giant cell arteritis (GCA). One case was due to an epidural tumorlike inflammatory lesion, the other to a concentric inflammatory thickening of the meninges. Both patients were highly corticodependent; they had low-titer anti-neutrophil cytoplasmic antibodies but no antimyeloperoxidase or antiproteinase 3 autoantibodies. The diagnosis was established by surgical biopsy. The histological pattern was reminiscent of Wegener granulomatosis. Both patients experienced relapse, despite high doses of corticosteroids, and experienced remission after the introduction of cyclophosphamide. Intravenous immunoglobulin perfusions were added for 1 patient. To our knowledge, spinal cord compression by a spinal pseudotumor or inflammatory meningitis has not been reported in the course of GCA. An overlap syndrome between GCA and Wegener granulomatosis is discussed.
Subject(s)
Giant Cell Arteritis/complications , Spinal Cord Compression/etiology , Aged , Biopsy , Diagnosis, Differential , Drug Therapy, Combination , Female , Follow-Up Studies , Giant Cell Arteritis/diagnosis , Giant Cell Arteritis/drug therapy , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Magnetic Resonance Imaging , Male , Spinal Cord Compression/diagnosis , Spinal Cord Compression/drug therapy , Syndrome , Thoracic Vertebrae , Tomography, X-Ray ComputedSubject(s)
Angioedema/chemically induced , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Capillary Leak Syndrome/chemically induced , Piroxicam/adverse effects , Adult , Angioedema/blood , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Biomarkers , Capillary Leak Syndrome/blood , Dilatation, Pathologic/diagnostic imaging , Dilatation, Pathologic/pathology , Female , Humans , Piroxicam/therapeutic use , Ultrasonography , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/pathologyABSTRACT
The association psoriasis and systemic lupus erythematosus (SLE) is a very uncommon association. We report three cases, diagnosed in an Internal Medicine department between 1993 and 2000. Few cases of psoriasis/SLE have been published in the literature. Psoriasis generally precedes the diagnosis of SLE. Psoriasis can also be associated with discoid lupus erythematosus. In some cases, SLE appears as a complication of ultraviolet phototherapy indicated for the psoriasis. The association psoriasis/SLE does not seem to have distinctive immunologic features. Specific therapeutic difficulties may occur. Indeed, hydroxychloroquine may exacerbate the psoriasis. Systemic use of corticosteroids raises the risk of severe psoriasis relapse during withdrawal. In addition, the diagnosis of psoriasic arthropathy is more difficult in this setting. The psoriasis/SLE association might be a good indication for using methotrexate.
