细胞巨乳病毒相关的并发症复杂化免疫检查点抑制剂相关的大肠炎
Michiko Yamada1, Tomoyuki Abe2, Seiyu Kubota2,3
1Department of Gastroenterology, Steel Memorial Muroran Hospital, 1-45 Chiribetsu-Cho, Muroran-Shi, Hokkaido, 050-0076, Japan. michiko.yamada.med@gmail.com.
在免疫检查点抑制剂治疗后,细胞巨乳病毒 (CMV) 相关的直肠可能发生. 在这种情况下,及时诊断和治疗valganciclovir导致了完全缓解.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 传染性疾病 传染性疾病
背景情况:
- 像 pembrolizumab 这样的免疫检查点抑制剂 (ICI) 可以导致免疫相关的不良事件 (irAEs),包括大肠炎.
- 皮质类固醇治疗是ICI诱导的大肠炎的常见治疗方法,但在类固醇逐渐减少期间可能会出现复发.
- 机会性感染,如细胞大脑病毒 (CMV),是免疫抑制的潜在并发症.
研究的目的:
- 报告一种与ICI诱导的大肠炎继发的CMV相关的直肠病例.
- 强调在免疫抑制疗法期间考虑患有复发性结肠炎的患者的机会性感染的重要性.
- 突出早期诊断和抗病毒治疗对CMV重新激活的有效性.
主要方法:
- 一名74岁的患有转移性肺癌的男性患者接受了 pembrolizumab 治疗,患上了复发性结肠炎.
- 进行了带有活检的诊断性结肠镜检查,揭示了直肠.
- 组织病理学检查和免疫组织化学染色证实了CMV感染.
- 开始使用瓦尔根西克洛维尔治疗.
主要成果:
- 患者出现严重的结肠炎和随后的直肠,在 pembrolizumab 治疗和高剂量皮质类固醇后.
- 组织病理学显示核包容体表明CMV感染,通过免疫组织化学证实.
- 瓦尔甘西克洛维尔治疗在四周内导致了完全的临床和病毒学缓解.
- 这一案例表明CMV是ICI诱导的大肠炎的次要并发症.
结论:
- 在ICI治疗和免疫抑制期间,应怀疑患有复发性或耐药性结肠炎的患者的CMV复激.
- 早期识别和及时的抗病毒治疗 (例如,瓦尔甘西克洛维尔) 对于管理CMV相关的直肠并发症至关重要.
- 在接受免疫抑制治疗的患者中,监测机会性感染是必不可少的,以防止严重的结果.
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