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Case Reports
. 2024 Aug 14:15:1370972.
doi: 10.3389/fimmu.2024.1370972. eCollection 2024.

IgA vasculitis induced by carboplatin + nab-paclitaxel + pembrolizumab in a patient with advanced lung squamous cell carcinoma: a case report

Yuto Terashima  1 , Masaru Matsumoto  1 , Saeko Ozaki  2 , Michiko Nakagawa  2 , Shun Nakagome  3 , Yasuhiro Terasaki  4 , Hiroki Iida  1 , Ryotaro Mitsugi  1 , Eri Kuramochi  1 , Naoko Okada  1 , Tomoyasu Inoue  1 , Satoru Matsuki  1 , Shingo Kitagawa  1 , Aya Fukuizumi  1 , Naomi Onda  1 , Susumu Takeuchi  1 , Akihiko Miyanaga  1 , Kazuo Kasahara  1 , Masahiro Seike  1
Affiliations
Case Reports

IgA vasculitis induced by carboplatin + nab-paclitaxel + pembrolizumab in a patient with advanced lung squamous cell carcinoma: a case report

Yuto Terashima et al. Front Immunol. .

Abstract

A 73-year-old man with lung squamous cell carcinoma was administered carboplatin + nab-paclitaxel + pembrolizumab for four cycles. Subsequently, he presented with multiple purpuras on his extremities, joint swelling on his fingers, abdominal pain, and diarrhea, accompanied by acute kidney injury (AKI), increased proteinuria, hematuria, and elevated C-reactive protein levels. Skin biopsy showed leukocytoclastic vasculitis as well as IgA and C3 deposition in the vessel walls. Based on these findings, the patient was diagnosed with IgA vasculitis as an immune-related adverse event (irAE) induced by carboplatin + nab-paclitaxel + pembrolizumab. After discontinuation of pembrolizumab and glucocorticoids, the symptoms immediately resolved. Regular monitoring of skin, blood tests, and urinalysis are necessary, and the possibility of irAE IgA vasculitis should be considered in cases of purpura and AKI during treatment with immune checkpoint inhibitors.

Keywords: IgA vasculitis; immune checkpoint inhibitor; immune-related adverse event; non-small-cell lung cancer; pembrolizumab.

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Conflict of interest statement

AM has received honoraria from AstraZeneca, Nippon Kayaku, Merck, Kyowa Kirin, and Pfizer. KK has received honoraria Chugai Pharmaceutical, Eli Lilly, and Bristol-Myers Squibb. MS has received grants and contracts from any entity from Taiho Pharmaceutical, Chugai Pharmaceutical, Eli Lilly, Nippon Boehringer Ingelheim, Nippon Kayaku, and Kyowa Hakko Kirin; honoraria from AstraZeneca, MSD K.K, Chugai Pharmaceutical, Taiho Pharmaceutical, Eli Lilly, Ono Pharmaceutical, Bristol-Myers Squibb, Nippon Boehringer Ingelheim, Pfizer, Novartis, Takeda Pharmaceutical, Kyowa Hakko Kirin, Nippon Kayaku, Daiichi-Sankyo Company, Merck Biopharma, and Amgen. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A–C) The patient developed multiple purpuras on his extremities. (D) CT revealed intestinal edema and ascites. (E) The purpura improved immediately after glucocorticoid treatment.
Figure 2
Figure 2
Clinical course of the patient and transition of creatinine levels after four cycles of carboplatin + nab-paclitaxel + pembrolizumab treatment, and diagnosed with irAE IgA vasculitis. Abbreviations: Cre, creatinine; CBDCA, carboplatin; nab-PTX, nab-paclitaxel; Pembro, pembrolizumab; AMPC/CVA, amoxicillin–clavulanate; ABPC/SBT, ampicillin–sulbactam; CTRX, ceftriaxone; mPSL, methylprednisolone; PSL, prednisolone.
Figure 3
Figure 3
Skin biopsy findings on the lower leg. (A, B) Hematoxylin and eosin staining showed neutrophil-dominated inflammatory cell infiltration from the small vessel walls into the surrounding tissues (scale bar [A] = 400 µm, [B] = 90 µm). (C) Immunofluorescence staining revealed granular IgA deposition in the vessel walls (×200). (D) Immunofluorescence staining revealed granular C3 deposition in the vessel walls (×200).
See this image and copyright information in PMC

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