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Case Reports
. 2019;58(5):699-702.
doi: 10.2169/internalmedicine.1001-18. Epub 2019 Mar 1.

Pembrolizumab-induced Autoimmune Hemolytic Anemia and Hemophagocytic Lymphohistiocytosis in Non-small Cell Lung Cancer

Sachi Okawa  1 , Hiroe Kayatani  1 , Keiichi Fujiwara  1 , Taichi Ozeki  1 , Kenji Takada  1 , Yoshitaka Iwamoto  1 , Daisuke Minami  1 , Ken Sato  1 , Takuo Shibayama  1
Affiliations
Case Reports

Pembrolizumab-induced Autoimmune Hemolytic Anemia and Hemophagocytic Lymphohistiocytosis in Non-small Cell Lung Cancer

Sachi Okawa et al. Intern Med. 2019.

Abstract

We herein report a 78-year old man with squamous cell carcinoma of the lungs treated with pembrolizumab. At 10 days after the administration of pembrolizumab, he showed progressive anemia and increased levels of bilirubin. Because the findings of a direct coombs test and cold hemagglutinin were positive, we diagnosed the patient with autoimmune hemolytic anemia and treated him with prednisolone. Subsequently, he was admitted to our hospital owing to fatigue, a high fever, and jaundice. His clinical findings met the diagnostic criteria of hemophagocytic lymphohistiocytosis, and he was rescued with a high dose of glucocorticoids. Marked tumor regression was obtained and has been maintained since then.

Keywords: autoimmune hemolytic anemia; hemophagocytic lymphohistiocytosis; immune checkpoint inhibitors; non-small cell lung cancer; pembrolizumab.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
A bone marrow examination showed hypocellular marrow with histiocytic hyperplasia and hemophagocytic macrophage infiltration (indicated with the arrow).
Figure 2.
Figure 2.
The clinical course after the first dose of pembrolizumab showing the dose and duration of steroid therapy and its efficacy for hemophagocytic lymphohistiocytosis. The high fever immediately resolved, and the serum lactate dehydrogenase and hemoglobin levels remarkably improved.
Figure 3.
Figure 3.
Computed tomography findings of the chest before pembrolizumab treatment (A). A mass can be observed in the right lower lobe of the lung. Mediastinal lymphadenopathy markedly regressed after glucocorticoid treatment for autoimmune hemolytic anemia and hemophagocytic lymphohistiocytosis as complications of pembrolizumab on day 73 after the first dose (B).
See this image and copyright information in PMC

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