Case ReportOpen Access

Unusual Adverse Effects of Immune Checkpoint Inhibitors: Autonomic Neuropathy, Palmoplantar Keratoderma, Reiter Syndrome & Myasthenia Gravis: A Case Series and Review of the Literature

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DOI: 10.23958/ijirms/vol05-i11/982· Pages: 554 - 560· Vol. 5, No. 11, (2020)· Published: November 23, 2020
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Abstract

The immune checkpoint inhibitors (ICIs) have transformed the standards of care in cancer treatment and has dramatically improved patient prognoses. As a result of the introduction of these novel treatments several types of adverse events related to ICIs (immune related adverse events ((irAEs)) have been observed and reported. In this case series we describe the clinical course of four patients, with unusual ICI induced toxicities. The first patient was a 59 year-old female who received chemo-immunotherapy (pembrolizumab) for stage 4- lung adenocarcinoma, and developed autonomic neuropathy (AN). The second and third patients were both 63 year-old males who also received chemo-immunotherapy (pembrolizumab) for stage 4-A lung adenocarcinoma. One of those patients developed palmoplantar keratoderma and one developed conjunctivitis, urethritis and arthritis (Reiter syndrome). The fourth patient was an 80 year-old male who received chemo-immunotherapy (pembrolizumab) for stage 3-A squamous cell carcinoma of the lung and developed myasthenia gravis.

Keywords

Pembrolizumab – Reiter Syndrome – Palmoplantar Keratoderma – Autonomic Neuropathy – Myasthenia Gravis – Immune
Author details
Walid Shalata
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
✉ Corresponding Author
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Alexander Yakobson
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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Ismaell Massalha
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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Aharon Y. Cohen
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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Iris M. Goldstein
Department of Neurology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Rachel Gibbs
Medical School for International Health and Sciences, Ben-Gurion University, Beer Sheva, Israel.
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Abu Saleh Omar
Department of Dermatology and Venereology, the Emek Medical Centre, Afula, Israel.
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Mohnnad Asla
Department of Neurology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Yulia Dudnik
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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Ali Abu-Juma'a
Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Nir Peled
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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Keren Rouvinov
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel
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