信迪利单抗致多个内分泌腺功能异常1例并文献复习

A case of multiple endocrine gland dysfunction caused by sintilimab and literature review

该院收治1例胃癌患者使用信迪利单抗治疗4个周期后停药,停药2个月后出现偏侧躯体皮疹,3个月后出现乏力、恶心、颜面部及双下肢水肿、顽固性低钠血症,完善实验室检查后诊断为苔藓样药疹、孤立性促肾上腺皮质激素缺乏症合并原发性甲状腺功能减退症。给予糖皮质激素及左旋甲状腺素钠生理剂量替代治疗、卤米松软膏外用后,患者临床症状改善、皮疹逐渐消退,复查电解质、皮质醇及甲状腺激素均正常。接受程序性死亡蛋白1抑制剂治疗的患者出现皮疹、乏力、恶心、全身水肿及顽固性低钠血症,要警惕皮肤及内分泌免疫相关不良事件的可能,应早诊断、早治疗,提高患者的生活质量。

This hospital admitted a patient with gastric cancer who was treated with sintilimab for four cycles and then stopped taking the drug.After stopping taking the drug for two months,the patient developed a lateral body rash,and after three months,fatigue,nausea,edema of face and lower limbs,and intractable hyponatremia occurred.After completing laboratory examination,he was diagnosed as lichenoid drug eruption,isolated adrenocorticotropic hormone deficiency complicated with primary hypothyroidism.The clinical symptoms of the patient were improved and the rash gradually subsided after the physiological dose replacement therapy of glucocorticoid and levothyroxine sodium and the external use of halometasone ointment,and the electrolytes,cortisol and thyroid hormones were normal after reexamination.If patients receiving programmed death protein 1 inhibitor treatment develop rash,fatigue,nausea,edema and refractory hyponatremia,it is necessary to be alert to the possibility of adverse events related to skin and endocrine system,early diagnosis and treatment,and improve the quality of life of patients.