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Review
. 2019 Oct 1;58(19):2839-2843.
doi: 10.2169/internalmedicine.2556-19. Epub 2019 Jun 27.

Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review

Shoko Murakami  1 , Tatsuya Nagano  1 , Kyosuke Nakata  1 , Akira Onishi  2 , Kanoko Umezawa  1 , Naoko Katsurada  1 , Masatsugu Yamamoto  1 , Motoko Tachihara  1 , Kazuyuki Kobayashi  1 , Yoshihiro Nishimura  1
Affiliations
Review

Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review

Shoko Murakami et al. Intern Med. .

Abstract

A 51-year-old man underwent second-line treatment for non-small-cell lung cancer (NSCLC) with the immune checkpoint inhibitor (ICI) pembrolizumab. On day 2 after two cycles of pembrolizumab, he presented with edema limited to the left third, fourth, and fifth fingers. Based on symptoms, laboratory results, and contrast-enhanced magnetic resonance imaging (MRI) findings, we diagnosed him with tenosynovitis. We prescribed oral prednisolone (0.5 mg/kg/day), and pembrolizumab was continued. Prednisolone immediately relieved the symptoms, and the tumor was still shrinking on day 21 after eight cycles of pembrolizumab. ICI-induced tenosynovitis was managed while continuing ICI usage, suggesting that 0.5 mg/kg/day prednisone might be effective for tenosynovitis without ICI cessation.

Keywords: pembrolizumab; prednisolone; tenosynovitis.

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Conflict of interest statement

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

Figures

Figure 1.
Figure 1.
Computed tomography (CT) revealed the shrinkage of the primary lesion (arrow) and the right adrenal gland metastasis before pembrolizumab (A and D), after four cycles of pembrolizumab (B and E), and after eight cycles of pembrolizumab (C and F).
Figure 2.
Figure 2.
Short-tau inversion-recovery (STIR) magnetic resonance imaging (MRI) showed high-intensity signals for the tenosynovium of the left third (A, arrow), fourth (B, arrow), and fifth fingers (C, arrow) and the right first finger (D, arrow).
Figure 3.
Figure 3.
The clinical course of the patient.
See this image and copyright information in PMC

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