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Management of multiorgan failure caused by immune checkpoint inhibitor toxicity

Tushita Verma1, Altamash Jawadi2, Shozab Ahmed3

  • 1Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA tverma@salud.unm.edu.

BMJ Case Reports
|February 17, 2025
PubMed

Insights

Immune checkpoint inhibitors (ICIs) can cause severe immune-related adverse events (irAEs), including fatal multiorgan failure. This case highlights the critical risks associated with ICI therapy, emphasizing early diagnosis and management of irAEs.

Area of Science:

  • Oncology
  • Immunology
  • Clinical Medicine

Background:

  • Immune checkpoint inhibitors (ICIs) are crucial in treating advanced cancers like lung adenocarcinoma.
  • Tumor cells exploit immune checkpoints to evade immune surveillance.
  • Immune-related adverse events (irAEs) are serious complications of ICI therapy.

Purpose of the Study:

  • To report a fatal case of immune-related adverse events (irAEs) in a patient receiving pembrolizumab.
  • To highlight the potential for severe, life-threatening complications from ICIs.
  • To underscore the importance of early irAE recognition and management.

Main Methods:

  • Case report of a patient with metastatic lung adenocarcinoma on pembrolizumab.
  • Presentation of acute stroke complicated by multiorgan failure attributed to irAEs.
  • Review of clinical course and treatment challenges.

Main Results:

  • The patient experienced an acute stroke and multiorgan failure secondary to irAEs.
  • Despite intensive care, the patient's condition deteriorated rapidly.
  • The patient passed away on the same day of critical illness progression.

Conclusions:

  • Immune checkpoint inhibitors carry a risk of severe and fatal immune-related adverse events.
  • Early and accurate diagnosis of irAEs is vital for patient outcomes.
  • Clinicians must maintain a high index of suspicion for irAEs in patients undergoing ICI treatment.
Keywords:
Cancer interventionImmune Checkpoint InhibitorsMalignant disease and immunosuppression

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