信迪利单抗致噬血细胞综合征1例

A case of hemophagocytic syndrome caused by sintilimab

1例69岁男性患者,诊断为“右肺腺癌伴骨转移”,2019年8月12日给予信迪利单抗注射液(200 mg,q 3 w,ivgtt)治疗2个周期。10月9日患者突发意识丧失,呼之不应。对症处理后意识恢复,但出现认知功能较差、反应迟钝、记忆力下降。后持续发热、皮肤及巩膜黄染加重、四肢乏力、小便茶色、大便黑色。10月23日骨髓穿刺检查示:增生性贫血骨髓像,可见吞噬型组织细胞。次日查血常规示:RBC 1.39×10^(12)·L^(-1)、Hb 41 g·L^(-1)、PLT 70×10^(9)·L^(-1);铁蛋白>1500.00 ng·mL^(-1);IL-2受体1636.00 U·mL^(-1),考虑为信迪利单抗所致噬血细胞综合征。予患者依托泊苷(150 mg·m^(-2),biw,ivgtt)联合地塞米松(10 mg·m^(-2),qd,ivgtt)治疗。2周后逐渐减量。8周后,患者认知功能恢复,记忆力好转,血象、皮肤巩膜等恢复正常,未再应用信迪利单抗治疗。

A 69-year-old male patient with right lung adenocarcinoma complicated with multiple bone metastases had been treated with sintilimab(200 mg,q 3 w,ivgtt)for two cycles since August 12^(th),2019.On October 9^(th),he had a sudden loss of consciousness and no response to call.After symptomatic treatment,the consciousness recovered,but the poor cognitive function,reaction and memory were left.And he further developed persistent fever,yellow staining of skin and sclera,limbs weakness,brown urine and black stool.Bone marrow biopsy on October 23^(rd) showed proliferative anemia of bone marrow and visible phagocytic histiocytes.On October 24^(th),results of blood routine examination showed that RBC 1.39×10^(12)·L^(-1),Hb 41 g·L^(-1),PLT 70×10^(9)·L^(-1),ferritin was>1500.00 ng·mL^(-1),IL-2 receptor was 1636.00 U·mL^(-1),which indicated the hemophagocytic syndrome caused by sintilimab.And etoposide(150 mg·m^(-2),biw,ivgtt)and dexamethasone(10 mg·m^(-2),qd,ivgtt)were given to him.Eight weeks later,his cognitive function recovered,his memory improved,the blood routine examination and his skin and sclera returned to normal.Sintilimab was not used again.