A Case of Repeated Cytokine Releasing Syndrome During Nivolumab Plus Ipilimumab Therapy, with Bacterial Infection Suspected as a Trigger for Relapse

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  • Matsuura Keigo
    Department of Respiratory Medicine, Hakodate Goryoukaku Hospital Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine
  • Sumi Toshiyuki
    Department of Respiratory Medicine, Hakodate Goryoukaku Hospital Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine
  • Fujimori Kento
    Department of Respiratory Medicine, Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital
  • Kamada Kouki
    Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine Department of Respiratory Medicine, Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital
  • Kobayashi Tomofumi
    Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine Department of Respiratory Medicine, Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital
  • Otsuka Mitsuo
    Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine Department of Respiratory Medicine, Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital
  • Ishigooka Taiki
    Department of Respiratory Medicine, Hakodate Goryoukaku Hospital Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine
  • Ikeda Takumi
    Department of Respiratory Medicine, Hakodate Goryoukaku Hospital Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine
  • Yamada Yuichi
    Department of Respiratory Medicine, Hakodate Goryoukaku Hospital Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine
  • Chiba Hirofumi
    Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine

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Other Title
  • ニボルマブ＋イピリムマブ療法中にサイトカイン放出症候群を繰り返し，再燃の契機として細菌感染症が疑われた1例

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<p>Background. Cytokine releasing syndrome (CRS) is a severe immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICIs). Although there have been reports of CRS recurrence, the risk factors for recurrence and factors that predict its severity remain unclear. Case report. A 75-year-old male was under postoperative surveillance for lung adenocarcinoma when pleural dissemination and malignant pleural effusion were detected. He was started on nivolumab and ipilimumab therapy. On day 16, he was admitted for drainage of the malignant pleural effusion. From day 24, he developed a fever, and on day 35, he experienced tonic-clonic seizures and hypoxemia. He was diagnosed with CRS and treated with steroid pulse therapy and tocilizumab, resulting in improvement, and he was discharged on day 72. However, on day 75, he developed fever and lower leg pain, and recurrent CRS triggered by cellulitis was suspected, leading to readmission on day 78. Despite treatment with steroids and antibiotics, his condition did not improve, and he subsequently died. Conclusion. Bacterial infection was considered a potential factor in the recurrence of CRS. During CRS treatment, even mild bacterial infections may trigger CRS onset, highlighting the need for prompt therapeutic intervention and careful monitoring.</p>

Journal

  • Haigan

    Haigan 65 (1), 54-59, 2025-02-20

    The Japan Lung Cancer Society

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