特殊临床表现多系统免疫相关不良事件1例

doi:10.3969/j.issn.1004-583X.2023.07.009

摘要/Abstract

摘要：

目的报道特殊临床表现多系统免疫相关不良事件个案,探讨本例免疫相关性不良反应发生的机制及危险因素,提高对该病的认识。方法分析本例患者的临床病例资料及诊治过程,并复习相关文献进行讨论。结果本例特殊临床表现多系统免疫相关不良事件患者,免疫相关性肺炎为G3,免疫相关性肝炎为G2,免疫相关性内分泌毒性G2。症状好转后仍死亡。结论特殊临床表现多系统免疫相关不良事件临床罕见,发病机制、危险因素、治疗方法仍存争议,虽发生率低,但预后差,值得进一步研究。

关键词: PD-1抑制剂, 卡瑞利珠单抗, 特殊临床表现, 免疫相关性不良事件

Abstract:

Objective To report a case of special clinical manifestations of multi system immune related adverse events, discuss the mechanism and risk factors of immune related adverse reactions in this case, and improve the understanding of the disease. Methods The clinical data, diagnosis and treatment process of this patient were analyzed, and the related literature was reviewed for discussion. Results In this patient with special clinical manifestations of multiple immune related adverse events, immune related pneumonia was G3, immune related hepatitis was G2, and immune related endocrine toxicity was G2. He still died after the symptoms improved. Conclusion The special clinical manifestations of multi system immune related adverse events are rare, and the pathogenesis and risk factors of treatment are still controversial. Although the incidence is low, the prognosis is poor, which is worth further study.

Key words: programmed death-1 inhibitor, camrelizumab, rare clinical manifestations, immune related adverse events

中图分类号:

R736.1

李阳, 默峰, 辛志飞, 王倩, 邓新娜. 特殊临床表现多系统免疫相关不良事件1例[J]. 临床荟萃, 2023, 38(7): 633-637.

Li Yang, Mo Feng, Xin Zhifei, Wang Qian, Deng Xinna. Multiple immune related adverse events with special clinical manifestations: A case report[J]. Clinical Focus, 2023, 38(7): 633-637.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.07.009

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I7/633

图/表 8

图1 免疫治疗前的影像学表现(2021-12-22) a.免疫治疗前PET/CT;b, c. 免疫治疗前肺部CT

Fig.1 Imaging findings before immunotherapy (2021-12-22) a. Pre-immunotherapy PET/CT; b, c. Pre-immunotherapy CT

图2 肺病理切片(HE×10)

Fig.2 Lung pathological section(HE×10)

图3 甲状腺病理切片(HE×10)

Fig.3 Thyroid pathological section(HE×10)

图4 痰

Fig.4 Sputum specimen

图5 支气管镜 a.左主支气管末端; b.气管隆突

Fig.5 Bronchoscope display a.End of main bronchus of left lung; b. Tracheal carina

图6 (痰)病理(HE×10)

Fig.6 Sputum pathological(HE× 10)

图7 临床过程

Fig.7 Clinical course

图8 CT显示免疫相关肺炎变化 a, b.第23天(2022-01-22)肺部CT显示肺炎;c, d.第29天(2022-01-28)肺炎的CT变化;e, f.第36天(2022-02-04)肺炎CT变化;g, h.第51天(2022-02-19)症状消失,肺炎基本消失

Fig.8 The CT image showing pneumonia change a, b. On the 23rd day (2022-01-22), CT findings of pneumonia; c, d. On the 29th day (2022-01-28), CT imaging showed the changes of pneumonia; e, f. On the 36th day (2022-02-04), CT imaging showed the changes of pneumonia; g, h. On the 51st day (2022-02-19), the symptoms disappeared and pneumonia basically

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