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

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

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


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
Issue number13
StatePublished - Sep 2021

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Oncology


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


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