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 reaction
Chihiro 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 Ogawa1DEDOI: 10.12659/AJCR.913021
Am J Case Rep 2019; 20:106-110
Abstract
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, Skin Neoplasms
In Press
16 Mar 2024 : Case report
Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case...Am J Case Rep In Press; DOI: 10.12659/AJCR.943010
16 Mar 2024 : Case report
A Rare Autochthonous Case of Hepatic Hydatid Cyst in the Non-Endemic Region of TaiwanAm J Case Rep In Press; DOI: 10.12659/AJCR.943687
17 Mar 2024 : Case report
Contrast-Enhanced Ultrasonography in Diagnosing Intravascular Large B-Cell Lymphoma Infiltrating Liver Sinu...Am J Case Rep In Press; DOI: 10.12659/AJCR.943070
17 Mar 2024 : Case report
Rare Presentation of Rapidly Involuting Congenital Hemangioma of the Skull: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943370
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250