6
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          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.

          Related collections

          Most cited references10

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Cytokine release syndrome

          During the last decade the field of cancer immunotherapy has witnessed impressive progress. Highly effective immunotherapies such as immune checkpoint inhibition, and T-cell engaging therapies like bispecific T-cell engaging (BiTE) single-chain antibody constructs and chimeric antigen receptor (CAR) T cells have shown remarkable efficacy in clinical trials and some of these agents have already received regulatory approval. However, along with growing experience in the clinical application of these potent immunotherapeutic agents comes the increasing awareness of their inherent and potentially fatal adverse effects, most notably the cytokine release syndrome (CRS). This review provides a comprehensive overview of the mechanisms underlying CRS pathophysiology, risk factors, clinical presentation, differential diagnoses, and prognostic factors. In addition, based on the current evidence we give practical guidance to the management of the cytokine release syndrome.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found
            Is Open Access

            Drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS): An update in 2019

            The aim of this review was to provide an updated overview of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS). Several new insights have been made, particularly with regards to the diagnosis, pathogenesis and care of some important complications and sequelae. The indication of herpesvirus reactivations in diagnosis in the assessment of disease severity is now better specified. Nevertheless, because fatal complications and autoimmune sequelae have been under-recognized, there is a clear need to identify effective parameters for assessing disease severity and predicting prognosis of the disease in the early phase. In this regard, we have established a scoring system that can be used to monitor severity, predict prognosis and stratify the risk of developing severe complications including fatal cytomegalovirus (CMV) disease. Regulatory T cells are likely to be central to the mechanism and would represent potential targets for therapeutic approaches that can ameliorate inflammatory responses occurring at the acute phase while preventing the subsequent development of harmful outcomes, such as CMV disease and autoimmune diseases.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Severe cytokine release syndrome in a patient receiving PD-1-directed therapy.

              Cytokine release syndrome (CRS) is a phenomenon of immune hyperactivation described in the setting of cellular and bispecific T-cell engaging immunotherapy. Checkpoint blockade using anti-programmed cell death 1 (anti-PD-1) inhibitors is an approach to antitumor immune system stimulation. A 29-year-old female with alveolar soft part sarcoma developed severe CRS after treatment with anti-PD-1 therapy. CRS was characterized by high fevers, encephalopathy, hypotension, hypoxia, hepatic dysfunction, and evidence of coagulopathy, and resolved after infusion of the interleukin-6 inhibitor tocilizumab and corticosteroids.
                Bookmark

                Author and article information

                Contributors
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                30 April 2021
                2021
                : 11
                : 681997
                Affiliations
                [1] 1 Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo, Japan
                [2] 2 Department of Emergency Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo, Japan
                [3] 3 Department of Infectious Diseases, Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo, Japan
                [4] 4 Department of Dermatology, Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo, Japan
                [5] 5 Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo, Japan
                [6] 6 Division of Cancer Immunotherapy Development, Advanced Medical Development Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo, Japan
                Author notes

                Edited by: Yoshihiko Hirohashi, Sapporo Medical University, Japan

                Reviewed by: Yoshihiro Komohara, Kumamoto University, Japan; Takayuki Okuri, Asahikawa Medical University, Japan

                *Correspondence: Tetsuya Urasaki, tetsuya.urasaki@ 123456jfcr.or.jp

                This article was submitted to Cancer Immunity and Immunotherapy, a section of the journal Frontiers in Oncology

                Article
                10.3389/fonc.2021.681997
                8121494
                33996612
                91554614-dda3-4839-b68c-88f78d080c7e
                Copyright © 2021 Urasaki, Ono, Mochizuki, Takeda, Nishizawa, Fukagawa, Fujiwara, Komai, Kitano, Yuasa, Yonese and Takahashi

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 March 2021
                : 12 April 2021
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 10, Pages: 6, Words: 2138
                Categories
                Oncology
                Case Report

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

                Comments

                Comment on this article