Case Report: A Case of Trimethoprim/Sulfamethoxazole-Triggered Hypotensive Shock: Cytokine Release Syndrome Related to Immune Checkpoint Inhibitors and Drug-Induced Hypersensitivity Syndrome.

cytokine release syndrome drug-induced hypersensitivity syndrome immune checkpoint inhibitor immune-related adverse event trimethoprim/sulfamethoxazole

Journal

Frontiers in oncology
ISSN: 2234-943X
Titre abrégé: Front Oncol
Pays: Switzerland
ID NLM: 101568867

Informations de publication

Date de publication:
2021
Historique:
received: 17 03 2021
accepted: 12 04 2021
entrez: 17 5 2021
pubmed: 18 5 2021
medline: 18 5 2021
Statut: epublish

Résumé

Currently, only a few reports exist on the cytokine release syndrome (CRS) as one of the severe immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICIs). Notably, it is very rare that grade 4 CRS related to ICI therapy overlaps with the drug-induced hypersensitivity syndrome (DiHS). A 46-year old woman with metastatic kidney cancer had grade 3 interstitial pneumonitis induced by four cycles of combination therapy of anti-programmed death-1 and anti-cytotoxic T lymphocyte-4 antibodies after right cytoreductive nephrectomy. Prophylactic administration of trimethoprim/sulfamethoxazole (TMP/SMX) was started concomitantly with prednisolone therapy to treat the interstitial pneumonitis. She developed hypotensive shock when reducing the dosage of prednisolone, and required intubation and ventilation using vasopressors at the intensive care unit. She subsequently exhibited prominent leukocytosis and an increased level of C-reactive protein, suggesting markedly increased cytokine levels. Interestingly, facial edema and erythema increased in association with pyrexia, leukocytosis, liver dysfunction, and renal failure, suggesting that she developed DiHS. She received hemodialysis three times, a plasma exchange, and anti-interleukin-6 therapy to treat severe renal dysfunction, a thrombotic thrombocytopenic purpura-suspected condition, and possible grade 4 CRS, respectively. Although these therapies did not elicit sufficient effects, high-dose administration of intravenous immunoglobulin was successful. With steroid mini-pulse therapy and the subsequent administration of prednisolone, she recovered successfully. To the best of our knowledge, this is the first report that ICIs and TMP/SMX can induce hypotensive shock accompanied with CRS and DiHS during immunosuppressive therapy for an irAE. Importantly, the prophylactic administration of TMP/SMX should be performed cautiously to avoid severe drug reactions such as CRS or DiHS.

Identifiants

pubmed: 33996612
doi: 10.3389/fonc.2021.681997
pmc: PMC8121494
doi:

Types de publication

Case Reports

Langues

eng

Pagination

681997

Informations de copyright

Copyright © 2021 Urasaki, Ono, Mochizuki, Takeda, Nishizawa, Fukagawa, Fujiwara, Komai, Kitano, Yuasa, Yonese and Takahashi.

Déclaration de conflit d'intérêts

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Références

J Oncol Pract. 2019 Sep;15(9):502-504
pubmed: 31310573
Allergol Int. 2019 Jul;68(3):301-308
pubmed: 31000444
Curr Allergy Asthma Rep. 2018 Jun 6;18(7):38
pubmed: 29876667
Pediatr Blood Cancer. 2017 Dec;64(12):
pubmed: 28544595
J Immunother. 2019 Jan;42(1):29-32
pubmed: 29939877
Intern Med. 2006;45(2):101-5
pubmed: 16484748
Case Rep Oncol. 2019 Feb 8;12(1):147-156
pubmed: 31043953
Medicine (Baltimore). 2020 Apr;99(15):e19741
pubmed: 32282733
J Immunother Cancer. 2018 Jun 15;6(1):56
pubmed: 29907163
J Immunother Cancer. 2019 Apr 3;7(1):97
pubmed: 30944043

Auteurs

Tetsuya Urasaki (T)

Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Makiko Ono (M)

Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Toshiaki Mochizuki (T)

Department of Emergency Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Koichi Takeda (K)

Department of Infectious Diseases, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Aya Nishizawa (A)

Department of Dermatology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Eri Fukagawa (E)

Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Motohiro Fujiwara (M)

Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Yoshinobu Komai (Y)

Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Shigehisa Kitano (S)

Division of Cancer Immunotherapy Development, Advanced Medical Development Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Takeshi Yuasa (T)

Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Junji Yonese (J)

Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Shunji Takahashi (S)

Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Classifications MeSH