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Severe Epididymo-Orchitis and Encephalitis Complicating Anti-PD-1 Therapy.
Quach, Henry T; Robbins, Charles J; Balko, Justin M; Chiu, Charles Y; Miller, Steve; Wilson, Michael R; Nelson, George E; Johnson, Douglas B.
Afiliação
  • Quach HT; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
  • Robbins CJ; Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
  • Balko JM; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Chiu CY; Department of Laboratory Medicine, University of California, San Francisco, California, USA.
  • Miller S; Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA.
  • Wilson MR; University of California-San Francisco-Abbott Viral Diagnostics and Discovery Center, San Francisco, California, USA.
  • Nelson GE; Department of Laboratory Medicine, University of California, San Francisco, California, USA.
  • Johnson DB; University of California-San Francisco-Abbott Viral Diagnostics and Discovery Center, San Francisco, California, USA.
Oncologist ; 24(7): 872-876, 2019 07.
Article em En | MEDLINE | ID: mdl-30936376
ABSTRACT

BACKGROUND:

Immune checkpoint inhibitors such as pembrolizumab and nivolumab have emerged as active treatment options for patients with many cancers, including metastatic melanoma, but can also cause symptomatic or life-threatening immune-related adverse events, including encephalitis. Epididymitis and orchitis are rare complications of these therapies. CASE PRESENTATION We describe herein a patient with metastatic melanoma who developed epididymo-orchitis followed by encephalitis while receiving pembrolizumab. The patient developed testicular pain and fever after his third dose of pembrolizumab; ultrasound evaluation demonstrated bilateral epididymo-orchitis. He then developed headaches, fever, and altered mental status over the next week and was admitted to the hospital. Lumbar puncture revealed inflammatory changes consistent with meningoencephalitis; he did not improve with broad-spectrum antibiotics, and an extensive workup for infectious etiologies, including cerebrospinal fluid testing using a clinical metagenomic next-generation sequencing assay, was negative. He received high-dose steroids for suspected autoimmune encephalitis, and both his orchitis and meningoencephalitis improved rapidly after one dose. He fully recovered after a 5-week taper of oral steroids.

DISCUSSION:

Here, we report a case of epididymo-orchitis complicating immune checkpoint inhibitor therapy. This patient subsequently developed severe encephalitis but rapidly improved with steroids. Clinicians should be aware of rare complications of these agents. KEY POINTS Epididymo-orchitis is a rare and potentially life-threatening complication of anti-programmed death protein 1 (anti-PD-1) therapy.For patients on anti-PD-1 therapy who develop either epididymo-orchitis or epididymitis without clear infectious cause, immune-related adverse events should be considered in the differential diagnosis.If severe, epididymo-orchitis related to anti-PD-1 therapy may be treated with high-dose corticosteroids.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Orquite / Neoplasias Uveais / Encefalite / Epididimite / Anticorpos Monoclonais Humanizados / Receptor de Morte Celular Programada 1 / Antineoplásicos Imunológicos / Melanoma Tipo de estudo: Prognostic_studies Limite: Aged / Humans / Male Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Orquite / Neoplasias Uveais / Encefalite / Epididimite / Anticorpos Monoclonais Humanizados / Receptor de Morte Celular Programada 1 / Antineoplásicos Imunológicos / Melanoma Tipo de estudo: Prognostic_studies Limite: Aged / Humans / Male Idioma: En Ano de publicação: 2019 Tipo de documento: Article