Abstract
Introduction: Immune checkpoint inhibitors targeting programmed death protein-1 and cytotoxic-T-lymphocyte-antigen-4 have revolutionized the treatment of various cancers. Despite their effectiveness, these therapies can lead to immune related adverse events. Observation: We reported a case of a 43- year-old white woman who was referred to our department for a management of acute polyarthritis. She was followed for a relapsing metastatic melanoma (stage IIIb) by surgery and Pembrolizumab, an immune checkpoint inhibitor targeting programmed death protein-1. After receiving her 4th cycle of this therapy she developed arthritis of the knees and the ankles, tenosynovitis and dry eyes with keratitis. After exclusion of other causes of polyarthritis such as connective-tissue disease, the diagnosis of rheumatologic immunerelated adverse events was retained. She was treated by 20 mg of prednisone daily, Pembrolizumab was discontinued. The evolution was favorable. Conclusion: Rheumatologic manifestations secondary to immune checkpoint inhibitors have been less well described in the literature. Their management requires the collaboration of oncologists and rheumatologists to limit the diagnostic delay and for an appropriate therapeutic choice according to their severity.
Highlights
Immune checkpoint inhibitors targeting programmed death protein-1 and cytotoxic-T-lymphocyte-antigen-4 have revolutionized the treatment of various cancers
We reported a case of polyarthritis that developed after treatment with Pembrolizumab, an Immune checkpoint inhibitors (ICIs) targeting PD-1
This disruption leads to clinical manifestations widely called immune related adverse events (irAEs) in the literature, which are toxicities that are autoimmune or autoinflammatory in origin [9]
Summary
Immune checkpoint inhibitors (ICIs) targeting programmed death protein-1 (PD-1) and cytotoxic-T-lymphocyte-antigen-4 (CTLA-4) have revolutionized the treat-. The widespread use of ICIs has led to remarkable clinical outcomes, with complete remissions and sustained clinical responses seen in some patients with previously refractory cancers such as metastatic melanoma, lung cancer, renal cell carcinoma, and Hodgkin lymphoma [3] [4]. Activating immune system to fight cancer can lead to immune related adverse events (irAEs) [3] [5]. These irAEs typically involve the skin, intestines, and endocrine system but virtually all organs can be affected [6]. We reported a case of polyarthritis that developed after treatment with Pembrolizumab, an ICI targeting PD-1
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