Pembrolizumab-Induced Cold Agglutinin Disease
| Autor: | Mohammad Omar Atiq, Zainab O Atiq, Omar Atiq, Vijay Patel, Saad O Atiq, Osman O Atiq |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Lung Neoplasms Cold agglutinin disease medicine.medical_treatment Pembrolizumab 030204 cardiovascular system & hematology Antibodies Monoclonal Humanized Gastroenterology 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine medicine Humans Lung cancer Cryoglobulins Chemotherapy business.industry Articles General Medicine Middle Aged medicine.disease Chemotherapy regimen Carboplatin chemistry 030220 oncology & carcinogenesis Female Rituximab Anemia Hemolytic Autoimmune Immunotherapy Autoimmune hemolytic anemia business medicine.drug |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| DOI: | 10.12659/ajcr.924283 |
| Popis: | Patient: Female, 58-year-old Final Diagnosis: Cold agglutinin disease • lung adenocarcinoma Symptoms: Anemia • fatigue • GI bleeding • neck mass • thrombocytopenia Medication:— Clinical Procedure: — Specialty: Hematology • General and Internal Medicine • Oncology Objective: Unusual clinical course Background: The introduction of immunotherapy in the management of metastatic lung cancer appears to be changing their natural history. Most patients tolerate immunotherapy without any significant adverse events. Nevertheless, a significant number of patients still experience adverse effects. Autoimmune hemolytic anemia has been described as mostly related to warm autoantibodies. The following case report describes cold agglutinin disease with hemolysis secondary to Pembrolizumab therapy for the treatment of metastatic lung cancer. Case Report: A 58-year-old woman noted a left neck mass 4 months prior to her presentation. A biopsy confirmed the presence of metastatic adenocarcinoma, consistent with primary lung cancer. Further evaluation revealed the tumor to be PDL-1-positive. She was started on Pembrolizumab, Pemetrexed, and carboplatin chemotherapy regimen. Her CBC was within normal limits when she started therapy, but within 4 weeks hemoglobin dropped to 4.3 g/dL. Further evaluation showed high cryoglobulin levels and a high cold agglutinin titer. Complement C3 DAT was positive. A peripheral smear showed clumps of red cells and the serum IgM was elevated. The diagnosis of CAD was made. She was then started on Rituximab. Imaging showed a significant response, with decreased disease burden. Conclusions: Our case shows a unique presentation of CAD, initially presumed to be myelosuppression secondary to chemo-therapy. Instead, a peripheral smear revealed Pembrolizumab to be the cause of cold agglutinin disease. Due to the relatively unknown association between these 2 entities, patient care was delayed. Finally, after initiation of Rituximab therapy, the patient’s CBC began to recover. |
| Databáze: | OpenAIRE |
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