対応に苦慮したニボルマブによる気管軟骨炎の1例

Abstract

Nivolumab-related tracheobronchial chondritis is an extremely rare immune-related adverse event. The patient was a 66-year-old male who had received radiotherapy for hypopharyngeal carcinoma two years ago, and then undergone surgery for local recurrence. Thereafter, due to recurrence of multiple lymph nodes, Nivolumab was administered every 2 weeks 19 times, every 4 weeks two times, and twice after one month of rest due to pneumonia. When he complained of fever, cough, sputum and fatigue, examinations revealed an increase of CRP value, swelling of the tracheobronchial wall, and intratracheal stenosis. An immuno-related adverse event was diagnosed and methylprednisolone was administered, which immediately improved the symptoms, swelling of the trachea and increased CRP value. However, during tapering of prednisolone, chondritis flared up. Second tapered treatment of prednisolone combined with methotrexate was carried out, but was insufficient. Tocilizumab was administered during the third tapered treatment of prednisolone. Matrix metalloproteinase-3 increased although the CRP value remained normal, therefore, colchicine was added. As a result, prednisolone was successfully tapered.