ニボルマブ・イピリムマブ併用療法による血球貧食症候群を発症した1例

A 59-year-old man was referred to our hospital for evaluation of a right renal mass demonstrated on abdominal ultrasound. A computed tomography (CT) scan showed a 4-cm ventral and 2-cm dorsal renal carcinoma in the middle pole of the right kidney. The left kidney was non-functioning. Kivolumab plus ipilimumab combination therapy was initiated for cTlaNOMO right renal cancer. Seven days after the second dose of chemotherapy, the patient was admitted to the hospital due to diarrhea and a fever. On the 4th day following admission, blood tests showed Grade 1 anemia, thrombocytopenia, an exceedingly high ferritin level, and elevation of interleukin-2 receptor. Bone marrow testing showed hemophagocytic images. He was diagnosed with hemophagocytic lymphohistiocytosis. High-dose steroid therapy produced a rapid clinical and biochemical response. The prednisone dose was gradually decreased, and the patient was discharged 26 days after admission. Hemophagocytic lymphohistiocytosis caused by immune checkpoint inhibitors is rare, but can be fatal in severe cases and therefore should be treated with caution.