Cargando…

Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma

A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal...

Descripción completa

Detalles Bibliográficos
Autores principales: Mullally, W. J., Cooke, F. J., Crosbie, I. M., Kumar, S., Abernethy, V. E., Jordan, E. J., O’Connor, M., Horgan, A. M., Landers, R., Naidoo, J., Calvert, P. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067158/
https://www.ncbi.nlm.nih.gov/pubmed/35514990
http://dx.doi.org/10.3389/fimmu.2022.871217
_version_ 1784699946618847232
author Mullally, W. J.
Cooke, F. J.
Crosbie, I. M.
Kumar, S.
Abernethy, V. E.
Jordan, E. J.
O’Connor, M.
Horgan, A. M.
Landers, R.
Naidoo, J.
Calvert, P. M.
author_facet Mullally, W. J.
Cooke, F. J.
Crosbie, I. M.
Kumar, S.
Abernethy, V. E.
Jordan, E. J.
O’Connor, M.
Horgan, A. M.
Landers, R.
Naidoo, J.
Calvert, P. M.
author_sort Mullally, W. J.
collection PubMed
description A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal pain, constipation, and fatigue. A computerized tomography scan did not identify a cause for his symptoms. This was rapidly followed by thrombocytopenia on day 11 and then anemia. He commenced intravenous corticosteroids for a suspected diagnosis of immune-related thrombocytopenia. On day 15, a generalized onset motor seizure occurred, and despite plasmapheresis later that day, the patient died from fatal immune-related thrombotic thrombocytopenic purpura (TTP). This was confirmed with suppressed ADAMTS13 (<5%) testing on day 14. Immune-related TTP is a rare and, in this case, fatal immune- related adverse event. Further studies are required to identify additional immunosuppressive management for immune-related TTP.
format Online
Article
Text
id pubmed-9067158
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-90671582022-05-04 Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma Mullally, W. J. Cooke, F. J. Crosbie, I. M. Kumar, S. Abernethy, V. E. Jordan, E. J. O’Connor, M. Horgan, A. M. Landers, R. Naidoo, J. Calvert, P. M. Front Immunol Immunology A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal pain, constipation, and fatigue. A computerized tomography scan did not identify a cause for his symptoms. This was rapidly followed by thrombocytopenia on day 11 and then anemia. He commenced intravenous corticosteroids for a suspected diagnosis of immune-related thrombocytopenia. On day 15, a generalized onset motor seizure occurred, and despite plasmapheresis later that day, the patient died from fatal immune-related thrombotic thrombocytopenic purpura (TTP). This was confirmed with suppressed ADAMTS13 (<5%) testing on day 14. Immune-related TTP is a rare and, in this case, fatal immune- related adverse event. Further studies are required to identify additional immunosuppressive management for immune-related TTP. Frontiers Media S.A. 2022-04-20 /pmc/articles/PMC9067158/ /pubmed/35514990 http://dx.doi.org/10.3389/fimmu.2022.871217 Text en Copyright © 2022 Mullally, Cooke, Crosbie, Kumar, Abernethy, Jordan, O’Connor, Horgan, Landers, Naidoo and Calvert https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Mullally, W. J.
Cooke, F. J.
Crosbie, I. M.
Kumar, S.
Abernethy, V. E.
Jordan, E. J.
O’Connor, M.
Horgan, A. M.
Landers, R.
Naidoo, J.
Calvert, P. M.
Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma
title Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma
title_full Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma
title_fullStr Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma
title_full_unstemmed Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma
title_short Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma
title_sort case report: thrombotic-thrombocytopenic purpura following ipilimumab and nivolumab combination immunotherapy for metastatic melanoma
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067158/
https://www.ncbi.nlm.nih.gov/pubmed/35514990
http://dx.doi.org/10.3389/fimmu.2022.871217
work_keys_str_mv AT mullallywj casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT cookefj casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT crosbieim casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT kumars casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT abernethyve casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT jordanej casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT oconnorm casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT horganam casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT landersr casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT naidooj casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma
AT calvertpm casereportthromboticthrombocytopenicpurpurafollowingipilimumabandnivolumabcombinationimmunotherapyformetastaticmelanoma