[Digital ischaemia with fingertip ulcers during ipilimumab therapy]

Abstract

Background: Anti-cancer drugs have many adverse effects including vascular side effects. Herein we present the case of a patient presenting digital ischaemia with high imputability of ipilimumab.

Observation: A 47-year-old male patient was treated for popliteal melanoma, initially stage IIIA but which subsequently became metastatic (stage IV), and for which ipilimumab was given after the failure of two lines of chemotherapy. During the 4th course of ipilimumab, the patient developed autoimmune hepatitis. Ipilimumab was suspended. Three months later, he developed a drug-like neuropathy followed one month later by ulceration of the right index finger. Causes of embolic, autoimmune and occupational origin (thrombotic microangiopathy, thrombosed aneurysm) were rapidly ruled out. Although a paraneoplastic origin could not be formally excluded, drug-induced immune disorder remained the most plausible origin.

Discussion: This is the first reported case of digital ulceration under ipilimumab.

Keywords: Acrosyndrome; Bloqueur de point de contrôle immunitaire; Drug toxicity; Finger ulcer; Immune checkpoint inhibitor; Ipilimumab; Melanoma; Mélanome; Toxicité médicamenteuse; Ulcère digital.