Polymyalgia rheumatica as a complication of immune checkpoint inhibitors treatment due to malignant melanoma


Authors: R. Roman 1;  Z. Řehák 2;  A. Poprach 3;  P. Němec 1
Authors‘ workplace: Fakultní nemocnice u sv. Anny v Brně, II. interní klinika, Oddělení revmatologie, Brno 1;  Masarykův onkologický ústav, Oddělení nukleární medicíny, Regionální centrum aplikované molekulární onkologie (RECAMO), Brno 2;  Masarykův onkologický ústav, Klinika komplexní onkologické péče, Brno 3
Published in: Čes. Revmatol., 26, 2018, No. 2, p. 80-86.
Category: Case Report

Overview

In recent years immune checkpoint inhibitors (ICI) have been used to treat malignant melanoma (MM). Their use is often accompanied with various grades of immune related adverse events (irAEs). Polymyalgia rheumatica (PMR) is of rare irAEs. PMR is an autoinflammatory condition characterized by stiffness around the shoulders and hip girdle. Guidelines for irAEs treatment have not yet been established. Recent reports have been based on clinical experience only. Most irAEs are responsive to glucocorticoids and therefore could be effectively treated by temporary immunosuppression. Also useful in less severe cases is delaying of ICI administration or symptomatic treatment. In more severe cases it is possible to treat by intravenous (i.v.) administration of glucocorticoids or by adding other immunosuppressants. Malignant melanomas are characterized by high accumulation of fludeoxyglucose (18F) (FDG). Therefore PET/CT imaging using FDG is ideal for diagnostics and monitoring of treatment response due to its high accumulation in malignant melanoma tissue. High accumulation of FDG is also detected in areas characteristic for PMR. Casuistics of sucessful treatment of a seventy-six-year-old patient in whom polymyalgia rheumatica developed as a result of MM treatment using ICI nivolumab is being presented.

Key words:

Polymyalgia rheumatica, malignant melanoma, immune checkpoint inhibitors, FDG PET/CT


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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