Polyarthritis, Tenosynovitis and Dry Eyes after Treatment by Immune Check-Point Inhibitors
2020
Introduction: Immune checkpoint inhibitors targeting programmed death
protein-1 and cytotoxic-T-lymphocyte-antigen-4 have revolutionized the treatment
of various cancers. Despite their effectiveness, these therapies can lead
to immune related adverse events. Observation: We reported a case of a 43-
year-old white woman who was referred to our department for a management
of acute polyarthritis. She was followed for a relapsing metastatic melanoma
(stage IIIb) by surgery and Pembrolizumab, an immune checkpoint
inhibitor targeting programmed death protein-1. After receiving her 4th cycle
of this therapy she developed arthritis of the knees and the ankles, tenosynovitis
and dry eyes with keratitis. After exclusion of other causes of polyarthritis
such as connective-tissue disease, the diagnosis of rheumatologic immunerelated
adverse events was retained. She was treated by 20 mg of prednisone
daily, Pembrolizumab was discontinued. The evolution was favorable. Conclusion: Rheumatologic manifestations secondary to immune checkpoint inhibitors
have been less well described in the literature. Their management
requires the collaboration of oncologists and rheumatologists to limit the diagnostic
delay and for an appropriate therapeutic choice according to their
severity.
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