RESUMEN
We report the first case of anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis as a systemic immune-related adverse event in a 64-year-old man receiving pembrolizumab to treat advanced lung cancer. The patient experienced hypothyroidism, myalgia, skin involvement, dyspnoea and diarrhoea. Laboratory tests revealed raised inflammatory markers, hypercreatinekinasemia and anti-MDA5 autoantibodies. Electroneuromyography and pathognomonic signs on physical examination confirmed the diagnosis of pauci-myopathic dermatomyositis. Pembrolizumab was discontinued and immunosuppressive therapy led to rapid and progressive improvement, with complete remission of dermatomyositis. This case report widens the spectrum of systemic immune-related adverse events associated with pembrolizumab.
Asunto(s)
Anticuerpos Monoclonales Humanizados , Dermatomiositis , Enfermedades Pulmonares Intersticiales , Neoplasias Pulmonares , Humanos , Masculino , Persona de Mediana Edad , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Autoanticuerpos , Dermatomiositis/inducido químicamente , Dermatomiositis/inmunología , Helicasa Inducida por Interferón IFIH1/inmunología , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedades Pulmonares Intersticiales/diagnóstico , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/complicacionesRESUMEN
Background: The "classic" thyroid gland arterial vascularization takes into account two superior thyroid arteries (STA), two inferior thyroid arteries (ITA) and, occasionally, a thyroid ima artery (TIMA). The present review focuses on exploring the available data concerning thyroid gland arterial vascularization and its variations. Methods: Here, we analysed 49 articles from the last century, ranging from case reports to reviews concerning cadaver dissection classes, surgical intervention, and non-invasive techniques as well. Results: The harvested data clearly highlighted that: (i) the STA originates predominantly from the external carotid artery; (ii) the ITA is a branch of the thyrocervical trunk; and (iii) the TIMA is a very uncommon variant predominantly occurring to compensate for ITA absence. Conclusion: A systematic review of a highly vascularized organ is of great relevance during surgical intervention and, thus, the knowledge of normal anatomy and its modification is essential both for fact-finding and in surgery.