Effective Treatment of a Melanoma Patient with Hemophagocytic Lymphohistiocytosis after Nivolumab and Ipilimumab Combined Immunotherapy.

Immune checkpoint inhibitors have significantly improved the prognosis of melanoma patients. However, these therapies may trigger unexpected immune-related adverse events (irAEs), which are challenging in making the proper diagnosis and providing treatment. Hematological toxicities are possible irAEs, but were poorly evaluated in clinical trials and treatment recommendations of this specific complications are limited. We present a stage IV melanoma patient who developed an extremely rare toxicity - hemophagocytic lymphohistiocytosis (HLH) after the 4th course of combined immunotherapy with nivolumab and ipilimumab. The patient was steroid resistant and only the treatment with various immunosuppressive agents provided control of the disease and finally melanoma regression. In this report, we evaluated the methods of HLH treatment and described our modification of available protocols. Immediate immunosuppression can be life-saving and due to rarity of this condition as well as lack of specific recommendations, every report is valuable for clinicians, especially when treatment was effective.

[The case of giant rhabdomyosarcoma of the head and neck and meagre symptomatology]. / Przypadek olbrzymiego miesaka prazkowanokomórkowego glowy i szyi o skapoobjawowym przebiegu klinicznym.

The case of the 27-year old patient with huge tumour of the right parotid gland was shown in this article. The right parotid gland, the right parapharyngeal space, region of the right maxillary sinus and the right temporal lobe of the brain were involved. Histopathological examination revealed alveolar rhabdomyosarcoma. The epidemiology, diagnostic problems and therapy were described.