A Case of Tracheal Focal Relapsing Polychondritis Induced by Pembrolizumab in Hypopharyngeal Cancer

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  • Kaido Tatsuya
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Yasui Hirotoshi
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Sakuma Tomohiro
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Mori Yasutaka
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Funasaka Takashi
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Yamada Chiaki
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Ito Takayasu
    Department of Respiratory Medicine, Nagoya University Hospital
  • Fukui Yasutaka
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Odate Mitsuru
    Department of Respiratory Medicine, Toyohashi Municipal Hospital
  • Makino Yasushi
    Department of Respiratory Medicine, Toyohashi Municipal Hospital

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Other Title
  • 下咽頭癌に対してPembrolizumab投与により発症した気管・気管支に限局した再発性多発軟骨炎の1例

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<p>Background. Although various immune-related adverse events have been reported with immune checkpoint inhibitors in malignancies, relapsing polychondritis (RP) including tracheal chondritis, is rare. Case. A 63-year-old man was diagnosed with left retropharyngeal administered squamous cell carcinoma (cT4aN2M0, cStage IVA) and radiation treatment (70 Gy) followed by 8 courses of cetuximab. Due to enlargement of the primary site leading to tracheal obstruction, he underwent tracheotomy and received second-line treatment with cisplatin+fluorouracil+pembrolizumab. After the fourth course, he developed a fever and high CRP levels and was found to have thickening of the tracheal wall on chest computed tomography; therefore, he underwent bronchoscopy. Multiple elevated lesions were found on the cartilage of the trachea, and inflammatory cell infiltration in the tracheal mucosa was observed on a biopsy taken from the same site. Suspecting RP, steroid treatment was initiated, and his fever and thickening of the tracheal wall improved. He later experienced recurrences twice and was diagnosed with RP limited to the trachea, as anti-type II collagen antibodies were positive during these recurrences. Conclusion. We encountered a rare case of RP induced by pembrolizumab treatment.</p>

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