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. 2022 Dec;71(12):3087-3092.
doi: 10.1007/s00262-022-03211-7. Epub 2022 May 16.

Checkpoint-inhibitor induced Polyserositis with Edema

Sarah Zierold  1   2 , Larissa Semra Akcetin  1 , Eva Gresser  3 , Anna Marie Maier  4 , Alexander König  4 , Rafaela Kramer  2   5   6   7 , Sebastian Theurich  8   9   10 , Dirk Tomsitz  1 , Michael Erdmann  5   6   7 , Lars E French  1   11 , Martina Rudelius  12 , Lucie Heinzerling  13   14   15
Affiliations

Checkpoint-inhibitor induced Polyserositis with Edema

Sarah Zierold et al. Cancer Immunol Immunother. 2022 Dec.

Abstract

Background: As immune checkpoint inhibitors (ICI) are increasingly being used due to effectiveness in various tumor entities, rare side effects occur more frequently. Pericardial effusion has been reported in patients with advanced non-small cell lung cancer (NSCLC) after or under treatment with immune checkpoint inhibitors. However, knowledge about serositis and edemas induced by checkpoint inhibitors in other tumor entities is scarce.

Methods and results: Four cases with sudden onset of checkpoint inhibitor induced serositis (irSerositis) are presented including one patient with metastatic cervical cancer, two with metastatic melanoma and one with non-small cell lung cancer (NSCLC). In all cases treatment with steroids was successful in the beginning, but did not lead to complete recovery of the patients. All patients required multiple punctures. Three of the patients presented with additional peripheral edema; in one patient only the lower extremities were affected, whereas the entire body, even face and eyelids were involved in the other patients. In all patients serositis was accompanied by other immune-related adverse events (irAEs).

Conclusion: ICI-induced serositis and effusions are complex to diagnose and treat and might be underdiagnosed. For differentiation from malignant serositis pathology of the punctured fluid can be helpful (lymphocytes vs. malignant cells). Identifying irSerositis as early as possible is essential since steroids can improve symptoms.

Keywords: Anti-PD1-antibody; Autoimmunity; Pericardial effusion; Pleural effusion; Serositis; Side effects.

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Conflict of interest statement

The authors declares that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A Case 1. CT angiography of the arteria pulmonalis. Pulmonary arterial contrast phase to rule out pulmonary embolism. Circular pericardial effusion with rim up to about 2 cm and low density enhancement up to about 20–30 HU (Hounsfield units). Furthermore, serous pleural effusion on the right of approximately 2 cm. B Case 3. PET/CT with 232 MBq F-18 FDG, venous phase. Serous pleural effusions (approximately 15 Hounsfield units). Right > left up to 6.2 cm. C Case 4. Marked four-quadrant ascites (approximately 5–10 Hounsfield units (HU)). Basal serous pericardial effusion approximately 1.5 cm (up to 10–15 HU) as well as serous pleural effusion on the right
Fig. 2
Fig. 2
A Giemsa staining of malignant pleural effusion. Carcinoma cells (*) are intermingled with granulocytes (G) and macrophages (M). B Giemsa staining of ICI-induced serous pleural effusion. Numerous segmented granulocytes and few serosa cells are displayed
See this image and copyright information in PMC

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