特瑞普利单抗致肌炎

Myositis induced by toripalimab

1例51岁女性卵巢癌患者接受5个周期的免疫、靶向联合化疗(帕博利珠单抗+贝伐珠单抗+伊立替康+顺铂)治疗,病情稳定;因个人原因,将帕博利珠单抗改为特瑞普利单抗,共治疗2个周期。末次治疗后2 d,患者周身出现红斑伴瘙痒、眼睑水肿,10 d后出现吞咽困难、构音障碍和肌力下降等症状。实验室检查示肌酸激酶2633 U/L,白介素648.69 ng/L,抗TIF1‑γ抗体阳性。四肢肌肉磁共振成像检查示符合肌炎表现,肌电图检查示左侧三角肌、胫前肌肌源性损伤。考虑为特瑞普利单抗所致肌炎。给予甲泼尼龙、静注人免疫球蛋白、托珠单抗等治疗16 d后,患者的全身红斑、眼睑水肿基本消退,肌酶谱持续下降,但仍存在吞咽困难、构音障碍。

A 51‑year‑old female patient with ovarian cancer was treated with 5 cycles of immunotherapy,targeted therapy,and chemotherapy(pablizumab+bevacizumab+irinotecan+cisplatin),and her disease condition was stable.After that,pabolizumab was changed to toripalimab for 2 cycles because of personal reason.Two days after the last treatments,the patient developed erythema with pruritus,and eyelid edema;10 days later,symptoms such as dysphagia,dysarthria,and decreased muscle strength appeared.Laboratory tests showed creatine kinase 2633 U/L,interleukin‑648.69 ng/L,positive anti‑TIF1‑γantibody.Magnetic resonance imaging of limb muscles showed myositis.Electromyography showed myogenic injury of the left deltoid and tibialis anterior muscles.It was considered that the myositis was caused by toripalimab.After 16 days of treatments with methylprednisolone,intravenous human immunoglobulin for intravenous injection,and tocilizumab,the patient′s systemic erythema and eyelid edema basically subsided,the muscle zymogram continued to decline,but dysphagia and dysarthria still existed.