Immune-Related Toxicity: Not always the Culprit

Ana Cardeña Gutiérrez, D. Mínguez, Mónica Esteban García, Elena García García, X. M. Rubio
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Abstract

He was admitted into the emergency room on September 2020 due to a three-day grade 3 emesis and rapidly progressive weight loss. Complementary studies showed grade 3 immune-related gastritis, with great response to corticosteroids within 2 days of treatment. He received metilprednisolone 1mg/kg/day for one month, and then, we started corticosteroid tapering. However, we could not lower the dose from prednisone 30 mg/day because grade 2 emesis and grade 2 diarrhea appeared. We considered starting Infliximab 5 mg/kg for corticosteroid refractory immunerelated toxicity(irAEs) but we needed an endoscopic study first, as ESMO guidelines recommend [1]. Pre-antiTNF screening with viral serologies an IGRA was negative.
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免疫相关的毒性:并不总是罪魁祸首
他于2020年9月因3天的3级呕吐和快速进行性体重减轻而被送进急诊室。补充研究显示,3级免疫相关性胃炎,在治疗2天内对皮质类固醇有很大的反应。他接受甲替强的松龙1mg/kg/天,持续一个月,然后我们开始逐渐减少皮质类固醇。然而,由于出现2级呕吐和2级腹泻,我们不能降低强的松30 mg/天的剂量。我们考虑开始使用英夫利昔单抗5mg /kg治疗皮质类固醇难治性免疫相关毒性(irAEs),但我们需要首先进行内镜研究,正如ESMO指南所建议的[1]。前抗tnf筛选与病毒血清学IGRA为阴性。
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