Open AccessNivolumab-induced systemic capillary leak syndrome as an ultra rare life-threatening phenomenon of late toxicity and intravenous immunoglobulin efficacy
Author(s) -
Ilya Polishchuk,
Alexander Yakobson,
Melanie Zemel,
Adam A Sharb,
Walid Shalata,
Eli S. Rosenberg,
Tawfeek A Kian,
Farouq Alguayn,
Nir Peled,
Keren Rouvinov,
Wafeek Alguayn,
Waleed Kian
Publication year - 2021
Publication title -
immunotherapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.127
H-Index - 48
eISSN - 1750-7448
pISSN - 1750-743X
DOI - 10.2217/imt-2020-0335
Subject(s) - medicine , anasarca , hemoconcentration , hypoalbuminemia , nivolumab , hyponatremia , anesthesia , surgery , gastroenterology , hematocrit , immunotherapy , cancer
Systemic capillary leak syndrome (SCLS) is a life-threatening disease. It is characterized by severe capillary hyperpermeability to proteins resulting in hemoconcentration, hypoalbuminemia and hypovolemic shock. Its treatment remains supportive, and the prognosis is generally poor. We report on a 51-year old male with melanoma treated with nivolumab for 1 year. 1 month following the completion of the treatment, the patient presented with signs of hypovolemic shock, anasarca, hemoconcentration and hypoalbuminemia. After excluding other diseases, a diagnosis of nivolumab-induced systemic capillary leak syndrome was made. A high dose of intravenous steroid therapy was promptly initiated without any significant clinical improvement. Intravenous immunoglobulin therapy was then administered with normalization of blood pressure, hemoconcentration and complete resolution of anasarca. Intravenous immunoglobulin should be considered a first-line treatment option for this rare phenomenon.