Abstract
BackgroundMalignant pleural mesothelioma (MPM) is a rare and aggressive tumour with an overall poor prognosis. In October 2020, first line treatment with the PD-1 antagonist nivolumab and the CTLA-4 antagonist ipilimumab for unresectable disease was FDA approved—the first approved treatment regime since 2004. Interim analyses from the phase 3 CHECKMATE-743 study shows improvements in overall survival. Skin-related toxicities are the most commonly reported any-grade treatment-related adverse event from combined nivolumab and ipilimumab therapy.Case presentationHere we report a case of a 35-year-old white male who developed digital ischaemia secondary to small vessel vasculitis after receiving PD-1 and CTLA-4 blockade therapy for MPM. His progressive ischaemia became gangrenous, and he required multi-speciality input and treatment with prednisolone, prostacyclin, mycophenolate mofetil and hydroxychloroquine.ConclusionsOur case highlights the importance of early detection, intervention, and a multispecialty approach to managing such complications in order to minimise the associated morbidity and mortality.
Highlights
Malignant pleural mesothelioma (MPM) is a rare and aggressive tumour with an overall poor prognosis
Combination therapy is associated with increased toxicity, Kefas et al BMC Rheumatology (2022) 6:10 attributed to the interaction of cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed death receptor-1 (PD-1) blockade
Case presentation We report on a 35-year-old white male who presented in April 2018 with a large, symptomatic pleural effusion secondary to a stage T2aN0M0 left-sided biphasic malignant pleural mesothelioma
Summary
Our case highlights the importance of early detection, intervention, and a multispecialty approach to managing such complications in order to minimise the associated morbidity and mortality.
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