Delayed cytokine release syndrome after neoadjuvant nivolumab: A case report and literature review

Aaron T. Ciner, Howard S. Hochster, David A. August, Darren R. Carpizo, Kristen R. Spencer

Research output: Contribution to journalReview articlepeer-review

Abstract

Aim: Cytokine release syndrome (CRS) is an infrequently described immune-related adverse event of checkpoint inhibitors (CPI). CPI-induced CRS typically presents with fevers, hemodynamic instability and organ dysfunction within 2 weeks of the last treatment cycle. Case study: We report an unusual case of delayed and severe CRS occurring postoperatively in a patient with hepatic-limited metastatic colorectal cancer who received neoadjuvant immunotherapy. After a negative workup for alternative causes, he received prolonged corticosteroid treatment with symptom resolution. Conclusion: CPI-induced CRS can mimic sepsis and clinicians should maintain a high-index of suspicion to diagnose this immune-related adverse event early and initiate appropriate treatment. As use of perioperative immunotherapy increases, the potential role of surgery to trigger CRS in this case warrants further investigation.

Original languageEnglish (US)
Pages (from-to)1071-1078
Number of pages8
JournalImmunotherapy
Volume13
Issue number13
DOIs
StatePublished - Sep 2021

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Oncology

Keywords

  • colorectal cancer
  • cytokine release syndrome
  • immunotherapy
  • neoadjuvant treatment
  • surgical-induced inflammation

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