A case of sudden renal dysfunction caused by pembrolizumab for malignant melanoma on the left heel and successfully treated with steroid

Abstract

An 83-year-old woman with rheumatoid arthritis noticed black nodules on her left heel. We observed a pedunculated black nodule sized 22×19×7mm on the left heel and left inguinal lymph node swelling. Positron emission tomography computed tomography (CT) showed abnormal uptake in 3 left inguinal lymph nodes. We performed total tumor resection with left inguinal lymph node dissection, and the diagnosis of malignant melanoma was confirmed. The left inguinal lymph node was positive (5/12) and staged as ⅢC, pT4bN3M0. As multiple organ metastases appeared on CT examination 3 months after surgery, we administered pembrolizumab. Three weeks after the initial administration, the patient’s serum creatinine level increased to 5.06 mg/dL. We diagnosed a grade 4 renal immune-related adverse event (irAE). After the administration of prednisolone at 30 mg/day (0.8 mg/kg/day), renal function gradually improved. In the present case, it was noteworthy that renal irAE appeared after a single administration of pembrolizumab.[Skin Cancer (Japan) 2018 ; 33 : 201-205]