Neuropsychiatric Immune-related Adverse Events Induced by Pembrolizumab in a Patient with Lung Adenocarcinoma and Systemic Lupus Erythematosus.

The patient was a 73-year-old woman with lung adenocarcinoma and systemic lupus erythematosus (SLE) who was treated with pembrolizumab. After six cycles of pembrolizumab, she developed symptoms suggestive of neuropsychiatric SLE, such as resting tremor, confusional state, depression, mood disorder, and anxiety disorder. In addition, her cerebrospinal fluid level of interleukin-6 was elevated. Her symptoms resolved one month after the discontinuation of pembrolizumab. This is the first report of neuropsychiatric symptoms in a patient with lung cancer and SLE on immune checkpoint blockade therapy.

A case of monoclonal gammopathy of undetermined significance with abnormal low levels of plasma glycated albumin by M protein.

BACKGROUND: It is known that an immunoglobulin abnormality affects various clinical laboratory measurements and leads to abnormal values. We experienced a case of monoclonal gammopathy of undetermined significance (MGUS) showing a falsely low plasma glycated albumin (GA) level. CASE REPORT: The patient was a 75-y-old male who visited our hospital for thrombocytosis identified during a medical checkup. Based on further examinations, he was diagnosed with MGUS (IgM-κ type). Laboratory examinations revealed that the plasma GA level was significantly low at -1.3% but the serum GA level was reasonable at 15.5%. We investigated the cause of the falsely low plasma GA level. RESULTS: The patient's plasma became turbid after mixing with the first reagent for GA measurement. The plasma GA level was increased by dilution of the plasma. The plasma GA level was falsely decreased only at the time of measurement on a sample collected using a blood-collecting tube with heparin sodium. The GA level was decreased by adding heparin sodium to the patient's serum, whereas the GA level was increased by neutralization of the patient's plasma with protamine sulfate. The GA level was increased after adding polyethylene glycol to the patient's plasma. Serum GA levels in healthy controls were decreased by adding purified M protein from the patient's serum. CONCLUSIONS: We report a patient with MGUS whose plasma GA concentration was falsely decreased by M protein when blood was drawn in a heparin sodium-containing tube.

A case of multicentric Castleman's disease demonstrating severe eosinophilia and enhanced production of interleukin-5.

INTRODUCTION: Castleman's disease (CD), idiopathic lymph-node hyperplasia, is a heterogeneous disease of unknown origin. Although the pathophysiology is yet to be elucidated, interleukin (IL)-6 produced by swollen lymph nodes has been reported to play a crucial role in CD. CASE REPORT: This report presents a case of a 37-yr-old man with CD showing marked elevation of IL-6, hypereosinophilia, and also IL-5 elevation. To date, IL-5 has not been reported to influence CD. However, because in this case the serum concentration of IL-5 produced from swollen lymph nodes paralleled the general symptoms, IL-5, in addition to IL-6, may have played an important role in the disease. DISCUSSION: Although in CD the serum IL-5 level is generally within the normal range, mild eosinophilia is a common complication of the disease. This case indicates that IL-5 can also influence eosinophilia. Taken together, this suggests that there may be a more general association between local production of IL-5 and the pathology of CD.