布罗利祖马布诱导的SJS-TEN重叠综合征的延迟呈现
Drew A Wells1,2, Gabriela Acton3, Zachery Halford3
1Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, Memphis, TN, USA.
概括
本案例研究报告了史蒂文斯-约翰逊综合征/有毒表皮解剖重叠的罕见实例,发生在潘布罗利祖马布治疗5个月后,强调长期警免疫相关不良事件 (irAEs).
科学领域:
- 在瘤学瘤学.
- 皮肤病学 皮肤病学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI),如 pembrolizumab 是关键的癌症疗法,但可以诱导严重的免疫相关不良事件 (irAEs).
- 史蒂文斯-约翰逊综合征 (SJS) 和有毒表皮解体 (TEN) 是罕见的,危及生命的irrAEs通常在治疗早期出现.
- 延迟发病的irAEs虽然不太常见,但需要持续监测.
研究的目的:
- 报告在布罗利祖马布停药后异常延迟的SJS/TEN重叠的情况.
- 为了突出IRAE表现的延长时间表.
- 为了强调持续警的重要意义,在患者有历史的irAEs.
主要方法:
- 这里介绍了一个67岁的女性患有三阴性乳腺癌的病例报告.
- 患者在停止服用pembrolizumab后大约五个月出现了扩散,疼痛的皮疹.
- 皮肤活检证实了SJS/TEN重叠,并指出了先前的布罗利祖马布诱导的肺炎.
主要成果:
- 最初用高剂量皮质类固醇治疗的效果是最小的.
- 增加静脉注射免疫球蛋白 (IVIG) 导致临床稳定.
- 患者经过类固醇逐渐减小和多学科护理,逐渐有所改善.
结论:
- 这种情况表明SJS/TEN重叠在pembrolizumab后异常晚发,延长了已知的irAE呈现窗口.
- 以前的肺炎可能增加了对皮肤毒性的敏感性.
- 积极的免疫抑制疗法取得了有利的结果,尽管预测死亡率高 (SCORTEN得分).
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