Severe Cytokine Release Syndrome and Immune Effector Cell-associated Neurotoxicity Syndrome in a Man Receiving Immune Checkpoint Inhibitors for Lung Cancer: A Case Report

Takaaki Tanaka; Masataka Taoka; Go Makimoto; Kiichiro Ninomiya; Hisao Higo; Masanori Fujii; Eiki Ichihara; Kadoaki Ohashi; Katsuyuki Hotta; Masahiro Tabata; Yoshinobu Maeda

doi:10.2169/internalmedicine.2429-23

This article has now been updated. Please use the final version.

Severe Cytokine Release Syndrome and Immune Effector Cell-associated Neurotoxicity Syndrome in a Man Receiving Immune Checkpoint Inhibitors for Lung Cancer: A Case Report

Takaaki Tanaka, Masataka Taoka, Go Makimoto, Kiichiro Ninomiya, Hisao Higo, Masanori Fujii, Eiki Ichihara, Kadoaki Ohashi, Katsuyuki Hotta, Masahiro Tabata, Yoshinobu Maeda

Author information

Takaaki Tanaka
Department of Respiratory Medicine, Okayama University Hospital, Japan
Masataka Taoka
Department of Respiratory Medicine, Okayama University Hospital, Japan
Go Makimoto
Department of Respiratory Medicine, Okayama University Hospital, Japan
Center for Clinical Oncology, Okayama University Hospital, Japan
Kiichiro Ninomiya
Center for Comprehensive Genomic Medicine, Okayama University Hospital, Japan
Hisao Higo
Department of Respiratory Medicine, Okayama University Hospital, Japan
Masanori Fujii
Department of Respiratory Medicine, Okayama University Hospital, Japan
Eiki Ichihara
Department of Respiratory Medicine, Okayama University Hospital, Japan
Kadoaki Ohashi
Department of Respiratory Medicine, Okayama University Hospital, Japan
Katsuyuki Hotta
Center for Innovative Clinical Medicine, Okayama University Hospital, Japan
Masahiro Tabata
Center for Clinical Oncology, Okayama University Hospital, Japan
Yoshinobu Maeda
Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan

Keywords: immune checkpoint inhibitor, nivolumab, ipilimumab, cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome

JOURNAL OPEN ACCESS Advance online publication

Article ID: 2429-23

DOI https://doi.org/10.2169/internalmedicine.2429-23

The final version of this article is now available: Vol. 63 (2024), No. 9 pp. 1261-1267

Details

Abstract

A 55-year-old man with stage IV lung adenocarcinoma was treated with cisplatin, pemetrexed, nivolumab, and ipilimumab. Approximately 100 days after treatment initiation, he became disoriented and presented to the emergency department with a high fever. Blood tests revealed liver and kidney dysfunctions. Subsequently, the patient developed generalized convulsions that required intensive care. He was clinically diagnosed with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Organ damage was gradually controlled with immunosuppressive drugs, including steroids, and the patient was discharged. Successful treatment is rare in patients with CRS, including ICANS, during immune checkpoint inhibitor treatment for solid tumors.

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