25 January 2019 : Case report
A Case of Acute Exacerbation of Chronic Adrenal Insufficiency Due to Ipilimumab Treatment for Advanced Melanoma
Unusual clinical course, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reactionChihiro Sakaguchi1ABCDEF, Seiichi Yano1CDE, Kenji Ashida21ABCDEF*, Naoko Wada3BCDE, Kenji Ohe4ACDE, Hiromi Nagata1DE, Yayoi Matsuda1DE, Shohei Sakamoto1DE, Ryuichi Sakamoto1DE, Keizo Ohnaka5DE, Hiroshi Uchi3DE, Masutaka Furue3DE, Masatoshi Nomura21ACDE, Yoshihiro Ogawa1DE
Am J Case Rep 2019; 20:106-110
BACKGROUND: Ipilimumab is a therapeutic human monoclonal antibody that targets the T-cell inhibitory molecule, cytotoxic T-lymphocyte antigen-4 (CTLA-4), and is classified as an immune checkpoint inhibitor that has been shown to improve prognosis in patients with advanced melanoma. However, several immune-related adverse events have been reported to be associated with ipilimumab Treatment. A case of acute exacerbation of chronic adrenal insufficiency is presented that highlights that glucocorticoid dosage for patients undergoing steroid treatment at the time of ipilimumab treatment has yet to be established.
CASE REPORT: A 50-year-old Japanese woman was diagnosed with malignant melanoma on the sole of her right foot. During her second course of ipilimumab treatment, she developed acute adrenal insufficiency caused by isolated adrenocorticotropic hormone (ACTH) deficiency, which required treatment with oral hydrocortisone. However, the symptoms of her adrenal insufficiency worsened, and she commenced treatment with 12 courses of nivolumab, a therapeutic human monoclonal antibody that blocks programmed cell death protein 1 (PD-1) on the surface of T-cells. She did not require corticosteroid support during nivolumab treatment.
CONCLUSIONS: This case report highlights the risk of exacerbating adrenal insufficiency during treatment with ipilimumab. The differences in clinical outcome in this patient between ipilimumab and nivolumab treatment might be explained by the different mechanisms between ipilimumab and nivolumab on immune function.
Keywords: adrenal insufficiency, CTLA-4 Antigen, Glucocorticoids, Melanoma, Programmed Cell Death 1 Receptor, Antineoplastic Agents, Immunological, Ipilimumab, Middle Aged, Skin Neoplasms
19 May 2022 : Case reportBilateral Emphysematous Pyelonephritis Associated with COVID Pneumonia: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case reportHigh-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case reportA case of exacerbation of haloperidol-induced rhabdomyolysis following the onset of COVID-19
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
23 May 2022 : Case reportPharmacological and Behavioral Strategies to Improve Vision in Acquired Pendular Nystagmus
Am J Case Rep In Press; DOI: 10.12659/AJCR.935148
23 May 2022 : Case reportA Case of Methicillin-Sensitive Staphylococcus aureus (MSSA) Prostate Abscess, Osteomyelitis, and Myositis ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936704
23 May 2022 : Case reportAdalimumab Mitigates Lumbar Radiculopathy in a Case of Ankylosing Spondylitis
Am J Case Rep In Press; DOI: 10.12659/AJCR.936600
Most Viewed Current Articles
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
17 Feb 2022 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep 2022; 23:e934399
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406