纳武利尤单抗与替吉奥联用致皮疹和免疫相关性肺炎

Skin rashes and immune‑associated pneumonitis caused by nivolumab combined with tegafur‑gimeracil‑oteracil potassium

1例69岁男性患者因胃腺癌伴肝脏、胰腺及腹腔淋巴结转移,在完成奥沙利铂联合雷替曲赛化疗4个周期后,改用纳武利尤单抗联合替吉奥治疗。10 d后患者全身出现严重皮疹,考虑为纳武利尤单抗和替吉奥所致皮肤不良反应,停用2药,给予甲泼尼龙和抗过敏药物治疗。皮疹逐渐好转,糖皮质激素逐步减量至停药。但停药当日患者出现发热、寒战、严重呼吸衰竭,结合临床治疗情况、实验室检查结果及影像学改变,考虑为纳武利尤单抗所致免疫相关性肺炎。给予甲泼尼龙、抗感染、经鼻高流量氧疗等治疗,4 d后患者喘憋症状较前明显好转,28 d后复查CT肺部炎症较前明显好转。

A 69‑year‑old male patient was treated with nivolumab combined with tegafur‑gimeraciloteracil potassium due to gastric adenocarcinoma with liver,pancreas,and abdominal lymph node metasta‑sis after completing 4 cycles of chemotherapy with oxaliplatin and raltitrexed.Ten days later,the patient developed severe rashes all over the body,which was considered to be adverse skin reactions caused by nivolumab and tegafur‑gimeracil‑oteracil potassium.Then the 2 drugs were stopped and treatments with methylprednisolone and antiallergic drugs were given.The rashes were gradually improved,the dose of gluco‑corticoid was reduced gradually,and it was stopped at last.However,on the day of glucocorticoid withdrawal,the patient developed fever,chills,and severe respiratory failure.In combination with clinical treatment,laboratory test results,and imaging changes in the patient,it was considered to be immune‑related pneumonitis caused by nivolumab.Methylprednisolone,anti‑infection,and high‑flow nasal cannula oxygen therapy were given.Four days later,the asthma symptoms in the patient were obviously improved,and 28 days later,the pulmonary CT showed the pneumonitis was markedly improved than before.