Iranian Journal of Immunology

Pulmonary Arterial Hypertension Induced by Immune Checkpoint Inhibitor Combined Therapy in a Patient with Intrahepatic Cholangiocarcinoma: A Case Report

Document Type : Case Report

Authors

Jingjing Zhang 1
Shasha Zhang 1
Shuo Xu 1
Xiaoyun Zhang 1
Jiasong Li 1
Zhengzheng Ji 1
Qingyi Liu 2
Zhanjun Guo 1

1 Department of Immunology and Rheumatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China.

2 Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, P.R. China.

https://doi.org/10.22034/iji.2023.96898.2464
Abstract
Immune Checkpoint Inhibitors (ICIs) have dramatically revolutionized the therapeutic approaches by which we treat a series of cancers accompanied by immune-related adverse events (irAEs). Herein, we reported an intrahepatic cholangiocarcinoma male patient with a history of ankylosing spondylitis developing pulmonary arterial hypertension (PAH) under ICI combined therapy with pembrolizumab and lenvatinib. The indirect measurement of cardiac ultrasound showed a pulmonary artery pressure (PAP) of 72mmHg after 21 three-week cycles of ICI combined therapy. The patient partially responded to the treatment of glucocorticoid and mycophenolate mofetil. The PAP decreased to 55mmHg 3 months after the ICI combined therapy was discontinued, but increased to 90mmHg after the ICI combined therapy was rechallenged. We treated him with adalimumab -an antitumor necrosis factor-alpha (ani-TNF-α) antibody- combined with glucocorticoid and immunosuppressants under lenvatinib monotherapy. The patient responded again with PAP decreasing to 67mmHg after 2 two-week cycles of adalimumab. Accordingly, we diagnosed him to have irAE-related PAH. Our findings supported the use of glucocorticoid disease-modifying antirheumatic drugs (DMARDs) as a treatment option in refractory PAH.

Keywords

Ankylosing Spondylitis
Immune-Related Adverse Events
Immune Checkpoint Inhibitors
Intrahepatic Cholangiocarcinoma
Pulmonary Arterial Hypertension
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Iranian Journal of Immunology
Volume 20, Issue 2
Spring 2023
Pages 240-246

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