Muscle weakness, myositis and scleroderma induced by durvalumab

Area of Science:

• Oncology
• Immunology
• Neurology
• Rheumatology

Background:

• Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment, improving prognoses across various malignancies.
• However, a spectrum of immune-related adverse events (irAE) can complicate therapy.
• The incidence and range of these irAEs are expected to increase with wider ICI use.

Purpose of the Study:

• To report a rare case of severe immune-related adverse events (irAE) associated with Durvalumab therapy.
• To describe the clinical presentation and diagnostic challenges of ICI-induced neurological and rheumatological conditions.
• To underscore the importance of early recognition and management of these rare toxicities.

Main Methods:

• A case report of a 72-year-old male with lung cancer treated with Durvalumab.
• Clinical evaluation including assessment for respiratory failure, muscular weakness, and pulmonary hypertension.
• Diagnostic workup included differential diagnoses for scleroderma-like syndrome and specific testing for RNA polymerase III antibodies.

Main Results:

• The patient developed respiratory failure secondary to myopathy and pulmonary hypertension.
• Differential diagnoses suggested scleroderma as a potential irAE.
• The case was confirmed as rare ICI-induced axonal polyneuropathy, myopathy, and RNA polymerase III-positive scleroderma.

Conclusions:

• Immune checkpoint inhibitor therapy can induce a rare but severe constellation of neurological and rheumatological complications.
• RNA polymerase III-positive scleroderma is a potential irAE of ICI, presenting with myopathy and polyneuropathy.
• Prompt identification and intervention are crucial for managing these debilitating irAEs and improving patient outcomes.