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Case Reports
. 2017 Jan 17:5:3.
doi: 10.1186/s40425-016-0205-2. eCollection 2017.

Interstitial nephritis in melanoma patients secondary to PD-1 checkpoint inhibitor

Julia Escandon  1 , Stephanie Peacock  2 , Asaad Trabolsi  2 , David B Thomas  3 , Ayman Layka  2 , Jose Lutzky  4
Affiliations
Case Reports

Interstitial nephritis in melanoma patients secondary to PD-1 checkpoint inhibitor

Julia Escandon et al. J Immunother Cancer. .

Abstract

Background: Immune checkpoint inhibitors have become the first line therapy in melanoma treatment and their use is extending to other malignancies. However, we are still learning about immune side effects produced by these drugs and their severity especially in patients with history of inflammatory diseases.

Case presentation: We present two cases of metastatic melanoma treated with nivolumab and pembrolizumab (anti PD-1). Both patients developed acute interstitial nephritis during immune checkpoint therapy. We emphasize the causal association between immune checkpoint inhibitors and the nephritis. The timing of drug administration and appearance of nephritis is suggestive of a causal relation between the checkpoint inhibitor therapy and this adverse event.

Conclusions: Although uncommon, some side effects from checkpoint inhibitors can be severe and may need to be addressed with immunosuppression. Given the increasing frequency of immunotherapy use, awareness should be raised in regards to immune side effects and their appropriate management.

Keywords: Immune checkpoint inhibitor; Interstitial nephritis; Nivolumab; PD-1 ligand (PD-L1); Pembrolizumab; Programed death 1 receptor (PD-1).

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Figures

Fig. 1
Fig. 1
a- b patient 1. c-d patient 2. a and c H&E 20x. Tubulointerstitial inflammation with eosinophils and acute tubular epithelial cell injury. b and c DIF 20x. IgG reactive interstitial plasma cells with tubulointerstitial inflammation
Fig. 2
Fig. 2
Immunohistochemistry of renal biopsies from patients 2 (top panel: a) and 1 (bottom panel: b) reveals an inflammatory infiltrate composed of CD4 and CD8 T-cells and macrophages.
See this image and copyright information in PMC

References

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