A case of Schönlein–Henoch purpura induced by immune checkpoint inhibitor in a patient with metastatic melanoma

Belkaid, Samy; Berger, Michel; Nouvier, Mathilde; Picard, Cécile; Dalle, Stéphane

doi:10.1016/j.ejca.2020.08.005

Cited by 10 publications

(6 citation statements)

References 10 publications

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“… 4 There are only two cases of IgA vasculitis during the treatment of ICIs, one case is a patient with squamous cell carcinoma of the lung during the treatment of anti-programmed cell death ligand 1 (PD-L1) antibody durvalumab, 5 the other case is a patient with metastatic melanoma during the treatment of nivolumab therapy. 2 To the best of our knowledge, our case is the second case of IgA vasculitis while undergoing anti-PD-1 antibody therapy. We summarize the cases of IgA vasculitis during ICI therapy in Table 1 .…”

Section: Discussionmentioning

confidence: 74%

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A Case of IgA Vasculitis During Nivolumab Therapy for Renal Cell Carcinoma

Nagaoka-Takatori¹,

Ishii²,

Hayama³

et al. 2021

CCID

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A 50-year-old Japanese woman presented with a 4-day history of multiple purpura on her extremities and myalgia. She had been receiving nivolumab therapy for stage IV renal cell carcinoma for 18 months. Nivolumab was temporarily discontinued due to liver dysfunction and resumed 3 months before. Biopsy specimen revealed leukocytoclastic vasculitis, and direct immunofluorescence showed deposition of IgA and C3 in the vessel walls of the upper dermis. Based on these findings, a diagnosis of IgA vasculitis was made. She was treated with 20 mg/day of oral prednisolone, which resulted in the complete disappearance of purpura and myalgia. Although the patient needed temporary cessation of nivolumab therapy, she experienced no recurrence of purpura or myalgia, and the dose of prednisolone was gradually tapered to 5 mg/day. Although nivolumab can lead to various immune-related adverse events, vasculitis is rare. To the best of our knowledge, this is the second case of IgA vasculitis during nivolumab therapy.

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Section: Discussionmentioning

confidence: 74%

“…Among them, cutaneous vasculitis is even rarer, and only one case of IgA vasculitis has been reported. 2 Herein, we report IgA vasculitis during nivolumab therapy.…”

Section: Introductionmentioning

confidence: 88%

A Case of IgA Vasculitis During Nivolumab Therapy for Renal Cell Carcinoma

Nagaoka-Takatori¹,

Ishii²,

Hayama³

et al. 2021

CCID

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“…Others mention drug-related IgAV in patients treated with vascular endothelial growth factor or immune checkpoint inhibitor. 16 , 17 Three cases of solid-organ malignancy diagnosed as HSP were instructive. Two had complete remission with a combination of immunosuppressive therapies for HSP and treatment of the associated malignancy.…”

Section: Discussionmentioning

confidence: 99%

IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy

Taoka¹,

Ochi²,

Mimura³

et al. 2021

TCRM

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A 72-year-old man with locally advanced lung squamous cell carcinoma experienced red purpura on the lower legs and hematuria when the disease progressed during definitive chemoradiotherapy. He had renal dysfunction and proteinuria. Biopsy specimens of the skin lesion and kidney revealed immunoglobulin A vasculitis. Potential causes such as paraneoplastic syndrome and cancer treatment have been proposed. The administration of steroids rapidly improved the symptoms. The presentation of immunoglobulin A vasculitis is accompanied by malignancies. Clinicians should keep this syndrome in mind, even during curative-intent treatment.

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“…Vasculitis is classified into large-, medium-, and small-vessel types depending on blood vessel size [ 116 ], but ICIs can cause any type of vasculitis. In fact, giant cell arteritis (GCA) [ 117 , 118 ], aortitis and large-vessel involvement [ 119 , 120 , 121 ], IgA vasculitis [ 122 , 123 ], granulomatosis with polyangiitis [ 124 , 125 ], eosinophilic granulomatosis with polyangiitis [ 126 ], and cutaneous small-vessel vasculitis [ 127 , 128 ] have been reported after ICI administration. A retrospective pharmacovigilance study evaluated the association between ICIs and cardiovascular adverse events and demonstrated that ICI treatment was associated with a higher risk of vasculitis when compared with the database obtained from individual case safety reports [ 129 ].…”

Section: Rheumatic Iraesmentioning

confidence: 99%

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

Dang¹,

Watanabe²,

Shiomi³

et al. 2023

IJMS

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With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such malignancies often interfere with RA treatment. Among several therapeutic agents, immune checkpoint inhibitors (ICIs) which antagonize immunological brakes on T lymphocytes have emerged as a promising treatment option for a variety of malignancies. In parallel, evidence has accumulated that ICIs are associated with numerous immune-related adverse events (irAEs), such as hypophysitis, myocarditis, pneumonitis, and colitis. Moreover, ICIs not only exacerbate pre-existing autoimmune diseases, but also cause de novo rheumatic disease–like symptoms, such as arthritis, myositis, and vasculitis, which are currently termed rheumatic irAEs. Rheumatic irAEs differ from classical rheumatic diseases in multiple aspects, and treatment should be individualized based on the severity. Close collaboration with oncologists is critical for preventing irreversible organ damage. This review summarizes the current evidence regarding the mechanisms and management of rheumatic irAEs with focus on arthritis, myositis, and vasculitis. Based on these findings, potential therapeutic strategies against rheumatic irAEs are discussed.

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A case of Schönlein–Henoch purpura induced by immune checkpoint inhibitor in a patient with metastatic melanoma

Cited by 10 publications

References 10 publications

A Case of IgA Vasculitis During Nivolumab Therapy for Renal Cell Carcinoma

A Case of IgA Vasculitis During Nivolumab Therapy for Renal Cell Carcinoma

IgA Vasculitis in a Lung Cancer Patient During Chemoradiotherapy

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

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