RESUMEN
The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. It is essential that patients with ICI-induced MG should be screened and monitored for myocarditis, a potentially fatal complication.
Asunto(s)
Insuficiencia Cardíaca/inducido químicamente , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Miastenia Gravis/inducido químicamente , Miocarditis/inducido químicamente , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/secundario , Diagnóstico Diferencial , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Inhibidores de Puntos de Control Inmunológico/administración & dosificación , Ipilimumab/administración & dosificación , Ipilimumab/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Masculino , Melanoma/tratamiento farmacológico , Melanoma/patología , Persona de Mediana Edad , Miastenia Gravis/diagnóstico por imagen , Miastenia Gravis/tratamiento farmacológico , Miocarditis/diagnóstico por imagen , Miocarditis/tratamiento farmacológico , Nivolumab/administración & dosificación , Nivolumab/efectos adversosAsunto(s)
Linfohistiocitosis Hemofagocítica/genética , Perforina/genética , Mutación Puntual , Anciano , Anciano de 80 o más Años , Predisposición Genética a la Enfermedad , Heterocigoto , Homocigoto , Humanos , Linfohistiocitosis Hemofagocítica/epidemiología , Polimorfismo de Nucleótido Simple , PrevalenciaRESUMEN
Radiotherapy (RT) can cause haemostasis in select cases of malignant bleeding. We present two cases where RT was used to prevent fatal exsanguination from bleeding skin malignancies. Treatment was with radical intent in one case and palliative intent in the other. The dose used in both cases was 20 Gray (Gy) in 5 fractions. To our knowledge, this is the first report of radiation-induced haemostasis in bleeding skin malignancies.
