PDF(Pubmed)
Abstract：
With the widespread use of immune checkpoint inhibitors to treat various cancers, pulmonary toxicity has become a topic of increasing concern. Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies are strongly associated with rapidly progressive interstitial lung disease (RP-ILD) in patients with clinically amyopathic dermatomyositis. However, anti-MDA5 antibody expression has not been reported in patients with immune-related adverse events. We present the case of a 74-year-old man with lung adenocarcinoma who developed RP-ILD after treatment with immune checkpoint inhibitors. Further investigation revealed multiple autoantibodies, including anti-MDA5 antibodies. He initially responded to systemic glucocorticoids, immunosuppressants, and tocilizumab but eventually died from worsening pneumomediastinum. This case is the first one to suggest that checkpoint inhibitor pneumonitis can present as RP-ILD with positive anti-MDA5 antibodies, which may be predictive of a poor prognosis.
摘要：
随着免疫检查点抑制剂广泛用于治疗各种癌症，肺毒性已成为人们日益关注的话题。抗黑素瘤分化相关基因5（抗MDA5）抗体与临床无肌病性皮肌炎患者的快速进行性间质性肺病（RP-ILD）密切相关。然而,在发生免疫相关不良事件的患者中,尚未有抗MDA5抗体表达的报道.我们介绍了一名74岁的肺腺癌患者，该患者在使用免疫检查点抑制剂治疗后发展为RP-ILD。进一步调查显示多种自身抗体,包括抗MDA5抗体。他最初对全身性糖皮质激素有反应，免疫抑制剂,和托珠单抗，但最终死于纵隔肺炎恶化。这个病例是第一个表明检查点抑制剂肺炎可以表现为RP-ILD与阳性的抗MDA5抗体，这可能预示着不良的预后。
