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Autoimmune fasciitis triggered by the anti-programmed cell death-1 monoclonal antibody nivolumab.
Parker, M Roberts, M Lorigan, Paul C du Plessis, D Chinoy, H
Parker, M
Roberts, M
Lorigan, Paul C
du Plessis, D
Chinoy, H
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Abstract
A 43-year-old woman with a history of recently diagnosed metastatic melanoma was commenced on systemic therapy with nivolumab, an anti-programmed cell death-1 monoclonal antibody and one of an increasing group of the so-called 'immune checkpoint inhibitors'. She experienced a dramatic complete response within 6 months of initiation. However, in addition to developing incident autoimmune hypothyroidism, she also developed progressive fatigue, proximal weakness, myalgia and dysphagia. Initial investigations with blood tests, electrophysiology and a muscle biopsy were non-specific or normal. Subsequent examination revealed 'woody' thickening of the subcutaneous tissues of the forearms, thighs and calves consistent with fasciitis. MRI and a full-thickness skin-muscle biopsy were ultimately diagnostic of a likely iatrogenic autoimmune myofasciitis. The clinical manifestations only responded partly to prednisolone 30 mg orally and treatment was escalated to include intravenous immunoglobulin. At 3 months, this has only resulted in a modest incremental improvement.
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2018-02-08
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Autoimmune fasciitis triggered by the anti-programmed cell death-1 monoclonal antibody nivolumab. 2018, BMJ Case Rep