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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.
This is a case report of a 67-year-old patient with castration resistant metastatic prostate cancer who developed an immune-mediated large vessel vasculitis following treatment with ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1).
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies which are being increasingly used as systemic anticancer therapies. They function by blockade of inhibitory pathways, which limit T-cell activity, therefore, allowing increased T-cell activity and antitumour immune responses.
Although ICIs have revolutionised the management of many patients with advanced malignancies, they are associated with a broad spectrum of immune-related adverse events (IRAEs), which can occur in any tissue or organ, during or after treatment. The most common IRAEs involve the skin, colon, endocrine organs and lungs.1
The incidence and prevalence of rheumatic IRAEs are not well reported.2 There are a small number of cases of ICI-mediated large vessel vasculitides described in the published literature, including one case of ICI-induced periaortitis and only one other reported case of ICI-induced aortitis.3–5
In April 2014, a 62-year-old man with a medical history of chronic lower back pain was diagnosed with metastatic prostate cancer with a presenting prostate specific antigen (PSA) of 1280 and retroperitoneal and paraaortic lymphadenopathy. He was commenced on androgen deprivation therapy with a good PSA response. After …
Contributors DH, GE, DP and DJ: conception and design of case report; acquisition, analysis and interpretation of data and drafting and revising the article. SC, RJ, PS, BK and ML: analysis and interpretation of data and drafting and revising the article. All authors gave final approval of the article and have agreed to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.