Multisystemic immune-related adverse events caused by toripalimab
10.3760/cma.j.cn114015-20240816-00732
- VernacularTitle:特瑞普利单抗致多系统免疫相关不良事件
- Author:
Qing MA
1
;
Jing FU
;
Wei CHEN
;
Weijun WANG
;
Kun CAO
;
Huiying HUANG
Author Information
1. 乐山市人民医院神经内科，乐山 614000
- Publication Type:Journal Article
- Keywords:
Melanoma;
Immune checkpoint inhibitors;
Toripalimab;
Multiple systems damage;
Immune-mediated hepatitis;
Immune-mediated myositis;
Immune-mediated myocardit
- From:
Adverse Drug Reactions Journal
2025;27(9):570-573
- CountryChina
- Language:Chinese
-
Abstract:
An 85-year-old male patient received immunotherapy with toripalimab (240 mg by intravenous infusion on day 1, 21 days as one treatment cycle). After one week of the first medication, the patient experienced fatigue, poor appetite, weight loss, gradually developed mild ptosis of the right eyelid, shortness of breath and palpitations after activity, which were progressively aggravated. The patient also developed unclear speech, choking on water, and difficulty breathing. Laboratory tests showed alanine aminotransferase (ALT) 93 U/L, aspartate aminotransferase (AST) 171 U/L, creatine kinase (CK) 2 982 U/L, creatine kinase isoenzyme (CK-MB) 110 U/L, lactate dehydrogenase (LDH) 603 U/L, and high-sensitivity troponin T (hs-cTnT) 243 ng/L. All indicators of thyroid function were abnormal. Based on results of the laboratory tests, neurophysiological examination, and electrocardiogram examination, combined with the patient′s clinical symptoms, immune-mediated hepatitis of grade 2, immune-mediated myocarditis of grade 3, myasthenia gravis of grade 3, immune-mediated myositis of grade 2, and thyroid dysfunction of grade 1 were diagnosed, which was considered to be induced by toripalimab. Toripalimab was stopped. After treatments with glucocorticoids, liver-protective drugs, and symptomatic treatments, above-mentioned indicators showed a downward trend. After 27 days of treatments, the patient′s clinical symptoms were improved significantly. Laboratory tests showed ALT 123 U/L, AST 68 U/L, CK 116 U/L, CK-MB 42 U/L, LDH 305 U/L. The thyroid function indicators were all normal. After 57 days of treatments, above symptoms in the patient basically disappeared, and laboratory indicators tended to be normal.
