PDF(Pubmed)
Abstract：
A patient in his 40s with splenic angiosarcoma metastatic to the liver underwent splenectomy, chemotherapy, and partial hepatectomy before being treated on a clinical trial with CTLA4 and PD1 inhibitors. He had received pneumococcal and meningococcal vaccines post-splenectomy. On week 10, he developed grade 3 immune-related colitis, successfully treated with the anti-tumor necrosis factor-alpha inhibitor infliximab and steroids. After 4 cycles of treatment, scans showed partial response. He resumed anti-PD1 therapy, and 6 hours after the second dose of anti-PD1 he presented to the emergency room with hematemesis, hematochezia, hypotension, fever, and oxygen desaturation. Laboratory tests demonstrated acute renal failure and septicemia (Streptococcus pneumoniae). He died 12 hours after the anti-PD1 infusion from overwhelming post-splenectomy infection (OPSI). Autopsy demonstrated non-viable liver tumors among other findings. In conclusion, patients undergoing immunotherapy and with prior history of asplenia should be monitored closely for OPSI as they may be at increased risk.
摘要：
一名40多岁的脾血管肉瘤转移到肝脏的患者接受了脾切除术，化疗,在使用CTLA4和PD1抑制剂进行临床试验之前进行部分肝切除术。他在脾切除术后接受了肺炎球菌和脑膜炎球菌疫苗。第10周，他患上了3级免疫相关性结肠炎，抗肿瘤坏死因子-α抑制剂英夫利昔单抗和类固醇治疗成功。经过4个周期的治疗，扫描显示部分反应。他恢复了抗PD1治疗,在服用第二剂PD1后6小时，他带着呕血来到急诊室，便血,低血压,发烧,和氧气去饱和。实验室检查显示急性肾衰竭和败血症（肺炎链球菌）。他在抗PD1输注后12小时死于压倒性的脾切除术后感染(OPSI)。尸检显示在其他发现中没有存活的肝肿瘤。总之,接受免疫疗法且既往有无脾病史的患者应密切监测OPSI,因为他们的OPSI风险可能增加.
