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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2022
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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 |
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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 |
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