卡瑞利珠单抗致严重口腔黏膜炎合并骨骼肌损伤1例

One Case of Immune-Related Oral Mucositis and Skeletal Muscle Injury Induced by Camrelizumab

目的:探讨卡瑞利珠单抗致口腔黏膜炎合并骨骼肌损伤的临床特点,以加强卡瑞利珠单抗用药监护,促进临床安全用药。方法:对1例85岁女性甲状腺癌患者应用卡瑞利珠单抗致严重口腔黏膜炎合并骨骼肌损伤的病例进行分析。结果:该患者接受静脉滴注注射用卡瑞利珠单抗200mg,每21天为一个周期。第2周期用药后第17天,患者诉颈、肩、背部肌肉疼痛,查血肌红蛋白(MYO)升高,用药前查血MYO、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)均正常。第3周期用药后第15天,查血MYO仍升高,cTnT、CK-MB正常,患者面部潮红,并出现严重口腔黏膜炎,疼痛明显,难以进食。给予氢化可的松等药物对症支持治疗后,患者面部潮红明显减轻,口腔黏膜炎明显减轻。出院后随访,患者未再应用注射用卡瑞利珠单抗,未再出现颈、肩、背部肌肉疼痛,未再出现口腔黏膜炎。结论:临床应用注射用卡瑞利珠单抗期间,需注意观察患者口腔黏膜情况,并注意检测血MYO值,若出现异常,应及时鉴别,并根据不良事件发生的严重程度给予及时处理,严重者需要停用卡瑞利珠单抗。

Objective:To investigate the clinical characteristics of camrelizumab-induced oral mucositis with skeletal muscle injury in order to enhance the monitoring of camrelizumab administration and promote its safeclinical use.Methods:A 85-year-old female with thyroid cancer,severe oral mucositis and skeletal muscle injury induced by camrelizumab was included in the analysis.Results:The patient received camrelizumab 200 mg ivgtt for 21 days.On the 17th day after the second cycle,the patient complained of pain in neck,shoulder and back muscles.Blood myoglobin(MYO)was found to be elevated.Before the treatment,MYO,cardiac troponin T(cTnT),and creatine kinase isoenzymes(CK-MB)were found to be normal.After the third cycle on the 15th day,MYO remained high,while cTnT and CK-MB were normal.The patient's face was flushed and severe oral mucosal inflammation occurred,with obvious pain and difficulty when eating.Medications such as hydrocortisone were given as symptomatic support for treatment.The patient's facial flushing and oral mucosal inflammation were significantly reduced after receiving treatment with a liquid diet.After discharge,the patient did not receive any further treatment with camrelizumab,and did not experience muscle pain in the neck,shoulder,or back,as well as oral mucosal inflammation.Conclusion:During the clinical application of camrelizumab,attention should be paid to observing the oral mucosa condition of patients and testing the blood MYO value.Any abnormalities should be identified in a timely manner and treated according to the severity of adverse events.In severe cases,camrelizumab should be discontinued.