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Acral vascular syndrome during an immune checkpoint inhibitor

Patrick O'Connor1, Pooja Bhadbhade2, Qamar Khan3

  • 1University of Kansas School of Medicine, Kansas City, Kansas, USA poconnor2@kumc.edu.

BMJ Case Reports
|May 20, 2020
PubMed

Insights

Immune checkpoint inhibitors can cause rare autoimmune side effects like acral vascular syndrome, leading to digital necrosis. This case highlights a patient experiencing this rare complication during cancer treatment.

Area of Science:

  • Oncology
  • Immunology
  • Dermatology

Background:

  • Immune checkpoint inhibitors (ICIs), such as anti-PD-1 and anti-CTLA-4, are crucial in cancer therapy.
  • These therapies can induce various autoimmune-related adverse events.
  • Acral vascular syndrome, a rare complication causing digital necrosis, has been linked to ICIs.

Observation:

  • A 45-year-old woman with breast cancer developed severe digital pain during neoadjuvant therapy with pembrolizumab.
  • Physical examination revealed ischemic necrosis and gangrene of the distal phalanx.
  • Angiography showed Raynaud's phenomenon, and lab tests revealed a weakly positive RNA polymerase III antibody.

Findings:

  • The patient presented with symptoms consistent with acral vascular syndrome.
  • Treatment with prednisone, vasodilators, and antibiotics provided partial symptom relief.
  • Surgical amputation of the affected digit was ultimately required.

Implications:

  • This case underscores the potential for rare but severe autoimmune complications from ICIs.
  • Early recognition and management of acral vascular syndrome are critical.
  • Understanding the link between ICIs, autoimmune responses, and vascular complications is essential for patient care.
Keywords:
oncologyunwanted effects / adverse reactionsvasculitis

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