Cytokine release syndrome induced by immune checkpoint inhibitor treatment for uterine cervical cancer recurrence: A case report

Sekimata,Mao; Kinjo,Yasuyuki; Tohyama,Atsushi; Murakami,Midori; Hashiwaki,Sayumi; Saito,Yuma; Higami,Shota; Hagimoto,Marina; Taketomi,Ruka; Hoshino,Kaori; Harada,Hiroshi; Ueda,Taeko; Kurita,Tomoko; Matsuura,Yusuke; Yoshino,Kiyoshi

doi:10.3892/ol.2024.14463

Cytokine release syndrome induced by immune checkpoint inhibitor treatment for uterine cervical cancer recurrence: A case report

Authors:
- Mao Sekimata
- Yasuyuki Kinjo
- Atsushi Tohyama
- Midori Murakami
- Sayumi Hashiwaki
- Yuma Saito
- Shota Higami
- Marina Hagimoto
- Ruka Taketomi
- Kaori Hoshino
- Hiroshi Harada
- Taeko Ueda
- Tomoko Kurita
- Yusuke Matsuura
- Kiyoshi Yoshino
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Affiliations: Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807‑8555, Japan
Published online on: May 17, 2024 https://doi.org/10.3892/ol.2024.14463
Article Number: 331
Copyright: © Sekimata et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Cytokine release syndrome (CRS) is a systemic inflammatory condition caused by an excessive immune response and cytokine overproduction. CRS is a life‑threatening condition that is often associated with chimeric antigen receptor T‑cell therapy. Despite the increased use of immune checkpoint inhibitors (ICIs), ICI‑induced CRS remains rare. The present study describes a case of CRS that occurred after the administration of ICIs for recurrent adenocarcinoma of the uterine cervix. A 49‑year‑old woman received paclitaxel, carboplatin and pembrolizumab for recurrent cervical adenocarcinoma. On day 27 of the third cycle, the patient was admitted with a fever and suspected pyelonephritis. The following day, hypotension, upper respiratory symptoms and myalgia of the extremities were noted, and the left ventricular ejection fraction (LVEF) was decreased to 20%. Multiorgan failure (MOF) occurred, and the patient received ventilator support and continuous hemodiafiltration. Rhabdomyolysis, pancreatitis, erythema multiforme and enteritis were observed. CRS was diagnosed based on elevated ferritin and IL‑6 levels. Steroid pulse therapy was administered; however, the MOF did not improve and the anti‑IL‑6‑receptor monoclonal antibody tocilizumab (TOC) was administered. Subsequently, the LVEF improved to 50%, and the patient was removed from the ventilator on day 4 and from the continuous hemodiafiltration unit on day 6 after TOC administration. The patient was discharged on day 21. In conclusion, considering that ICI‑induced CRS is a rare but severe complication, fever and other systemic conditions following ICI administration should be monitored.

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