Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review
Identifieur interne : 000297 ( Pmc/Corpus ); précédent : 000296; suivant : 000298Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review
Auteurs : Shoko Murakami ; Tatsuya Nagano ; Kyosuke Nakata ; Akira Onishi ; Kanoko Umezawa ; Naoko Katsurada ; Masatsugu Yamamoto ; Motoko Tachihara ; Kazuyuki Kobayashi ; Yoshihiro NishimuraSource :
- Internal Medicine [ 0918-2918 ] ; 2019.
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.
Url:
DOI: 10.2169/internalmedicine.2556-19
PubMed: 31243239
PubMed Central: 6815895
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review</title><author><name sortKey="Murakami, Shoko" sort="Murakami, Shoko" uniqKey="Murakami S" first="Shoko" last="Murakami">Shoko Murakami</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Nagano, Tatsuya" sort="Nagano, Tatsuya" uniqKey="Nagano T" first="Tatsuya" last="Nagano">Tatsuya Nagano</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Nakata, Kyosuke" sort="Nakata, Kyosuke" uniqKey="Nakata K" first="Kyosuke" last="Nakata">Kyosuke Nakata</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Onishi, Akira" sort="Onishi, Akira" uniqKey="Onishi A" first="Akira" last="Onishi">Akira Onishi</name><affiliation><nlm:aff id="aff2">Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Umezawa, Kanoko" sort="Umezawa, Kanoko" uniqKey="Umezawa K" first="Kanoko" last="Umezawa">Kanoko Umezawa</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Katsurada, Naoko" sort="Katsurada, Naoko" uniqKey="Katsurada N" first="Naoko" last="Katsurada">Naoko Katsurada</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Yamamoto, Masatsugu" sort="Yamamoto, Masatsugu" uniqKey="Yamamoto M" first="Masatsugu" last="Yamamoto">Masatsugu Yamamoto</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Tachihara, Motoko" sort="Tachihara, Motoko" uniqKey="Tachihara M" first="Motoko" last="Tachihara">Motoko Tachihara</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Kobayashi, Kazuyuki" sort="Kobayashi, Kazuyuki" uniqKey="Kobayashi K" first="Kazuyuki" last="Kobayashi">Kazuyuki Kobayashi</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Nishimura, Yoshihiro" sort="Nishimura, Yoshihiro" uniqKey="Nishimura Y" first="Yoshihiro" last="Nishimura">Yoshihiro Nishimura</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31243239</idno><idno type="pmc">6815895</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815895</idno><idno type="RBID">PMC:6815895</idno><idno type="doi">10.2169/internalmedicine.2556-19</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000297</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000297</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review</title><author><name sortKey="Murakami, Shoko" sort="Murakami, Shoko" uniqKey="Murakami S" first="Shoko" last="Murakami">Shoko Murakami</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Nagano, Tatsuya" sort="Nagano, Tatsuya" uniqKey="Nagano T" first="Tatsuya" last="Nagano">Tatsuya Nagano</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Nakata, Kyosuke" sort="Nakata, Kyosuke" uniqKey="Nakata K" first="Kyosuke" last="Nakata">Kyosuke Nakata</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Onishi, Akira" sort="Onishi, Akira" uniqKey="Onishi A" first="Akira" last="Onishi">Akira Onishi</name><affiliation><nlm:aff id="aff2">Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Umezawa, Kanoko" sort="Umezawa, Kanoko" uniqKey="Umezawa K" first="Kanoko" last="Umezawa">Kanoko Umezawa</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Katsurada, Naoko" sort="Katsurada, Naoko" uniqKey="Katsurada N" first="Naoko" last="Katsurada">Naoko Katsurada</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Yamamoto, Masatsugu" sort="Yamamoto, Masatsugu" uniqKey="Yamamoto M" first="Masatsugu" last="Yamamoto">Masatsugu Yamamoto</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Tachihara, Motoko" sort="Tachihara, Motoko" uniqKey="Tachihara M" first="Motoko" last="Tachihara">Motoko Tachihara</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Kobayashi, Kazuyuki" sort="Kobayashi, Kazuyuki" uniqKey="Kobayashi K" first="Kazuyuki" last="Kobayashi">Kazuyuki Kobayashi</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author><author><name sortKey="Nishimura, Yoshihiro" sort="Nishimura, Yoshihiro" uniqKey="Nishimura Y" first="Yoshihiro" last="Nishimura">Yoshihiro Nishimura</name><affiliation><nlm:aff id="aff1">Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</nlm:aff></affiliation></author></analytic><series><title level="j">Internal Medicine</title><idno type="ISSN">0918-2918</idno><idno type="eISSN">1349-7235</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>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. </p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Haanen, Jb" uniqKey="Haanen J">JB Haanen</name></author><author><name sortKey="Thienen, H" uniqKey="Thienen H">H Thienen</name></author><author><name sortKey="Blank, Cu" uniqKey="Blank C">CU Blank</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Good Jacobson, Kl" uniqKey="Good Jacobson K">KL Good-Jacobson</name></author><author><name sortKey="Szumilas, Cg" uniqKey="Szumilas C">CG Szumilas</name></author><author><name sortKey="Chen, L" uniqKey="Chen L">L Chen</name></author><author><name sortKey="Sharpe, Ah" uniqKey="Sharpe A">AH Sharpe</name></author><author><name sortKey="Tomayko, Mm" uniqKey="Tomayko M">MM Tomayko</name></author><author><name sortKey="Shlomchik, Mj" uniqKey="Shlomchik M">MJ Shlomchik</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zitvogel, L" uniqKey="Zitvogel L">L Zitvogel</name></author><author><name sortKey="Kroemer, G" uniqKey="Kroemer G">G Kroemer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Iwama, S" uniqKey="Iwama S">S Iwama</name></author><author><name sortKey="De Remigis, A" uniqKey="De Remigis A">A De Remigis</name></author><author><name sortKey="Callahan, Mk" uniqKey="Callahan M">MK Callahan</name></author><author><name sortKey="Slovin, Sf" uniqKey="Slovin S">SF Slovin</name></author><author><name sortKey="Wolchok, Jd" uniqKey="Wolchok J">JD Wolchok</name></author><author><name sortKey="Caturegli, P" uniqKey="Caturegli P">P Caturegli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Postow, Ma" uniqKey="Postow M">MA Postow</name></author><author><name sortKey="Sidlow, R" uniqKey="Sidlow R">R Sidlow</name></author><author><name sortKey="Hellmann, Md" uniqKey="Hellmann M">MD Hellmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cappelli, Lc" uniqKey="Cappelli L">LC Cappelli</name></author><author><name sortKey="Gutierrez, Ak" uniqKey="Gutierrez A">AK Gutierrez</name></author><author><name sortKey="Bingham, Co" uniqKey="Bingham C">CO Bingham</name></author><author><name sortKey="Shah, Aa" uniqKey="Shah A">AA Shah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcgonagle, D" uniqKey="Mcgonagle D">D McGonagle</name></author><author><name sortKey="Tan, Al" uniqKey="Tan A">AL Tan</name></author><author><name sortKey="Watad, A" uniqKey="Watad A">A Watad</name></author><author><name sortKey="Helliwell, P" uniqKey="Helliwell P">P Helliwell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sherlock, Jp" uniqKey="Sherlock J">JP Sherlock</name></author><author><name sortKey="Joyce Shaikh, B" uniqKey="Joyce Shaikh B">B Joyce-Shaikh</name></author><author><name sortKey="Turner, Sp" uniqKey="Turner S">SP Turner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sakaguchi, N" uniqKey="Sakaguchi N">N Sakaguchi</name></author><author><name sortKey="Takahashi, T" uniqKey="Takahashi T">T Takahashi</name></author><author><name sortKey="Hata, H" uniqKey="Hata H">H Hata</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vieira Sousa, E" uniqKey="Vieira Sousa E">E Vieira-Sousa</name></author><author><name sortKey="Van Duivenvoorde, Lm" uniqKey="Van Duivenvoorde L">LM van Duivenvoorde</name></author><author><name sortKey="Fonseca, Je" uniqKey="Fonseca J">JE Fonseca</name></author><author><name sortKey="Lories, Rj" uniqKey="Lories R">RJ Lories</name></author><author><name sortKey="Baeten, Dl" uniqKey="Baeten D">DL Baeten</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Mm" uniqKey="Chan M">MM Chan</name></author><author><name sortKey="Kefford, Rf" uniqKey="Kefford R">RF Kefford</name></author><author><name sortKey="Carlino, M" uniqKey="Carlino M">M Carlino</name></author><author><name sortKey="Clements, A" uniqKey="Clements A">A Clements</name></author><author><name sortKey="Manolios, N" uniqKey="Manolios N">N Manolios</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cappelli, Lc" uniqKey="Cappelli L">LC Cappelli</name></author><author><name sortKey="Gutierrez, Ak" uniqKey="Gutierrez A">AK Gutierrez</name></author><author><name sortKey="Baer, An" uniqKey="Baer A">AN Baer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Mh" uniqKey="Smith M">MH Smith</name></author><author><name sortKey="Bass, Ar" uniqKey="Bass A">AR Bass</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Inamo, J" uniqKey="Inamo J">J Inamo</name></author><author><name sortKey="Kaneko, Y" uniqKey="Kaneko Y">Y Kaneko</name></author><author><name sortKey="Takeuchi, T" uniqKey="Takeuchi T">T Takeuchi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Blood, Td" uniqKey="Blood T">TD Blood</name></author><author><name sortKey="Morrell, Nt" uniqKey="Morrell N">NT Morrell</name></author><author><name sortKey="Weiss, Ap" uniqKey="Weiss A">AP Weiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arbour, Kc" uniqKey="Arbour K">KC Arbour</name></author><author><name sortKey="Mezquita, L" uniqKey="Mezquita L">L Mezquita</name></author><author><name sortKey="Long, N" uniqKey="Long N">N Long</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Horvat, Tz" uniqKey="Horvat T">TZ Horvat</name></author><author><name sortKey="Adel, Ng" uniqKey="Adel N">NG Adel</name></author><author><name sortKey="Dang, To" uniqKey="Dang T">TO Dang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weber, Js" uniqKey="Weber J">JS Weber</name></author><author><name sortKey="Larkin, Jmg" uniqKey="Larkin J">JMG Larkin</name></author><author><name sortKey="Schadendorf, D" uniqKey="Schadendorf D">D Schadendorf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Santini, Fc" uniqKey="Santini F">FC Santini</name></author><author><name sortKey="Rizvi, H" uniqKey="Rizvi H">H Rizvi</name></author><author><name sortKey="Wilkins, O" uniqKey="Wilkins O">O Wilkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tachihara, M" uniqKey="Tachihara M">M Tachihara</name></author><author><name sortKey="Negoro, S" uniqKey="Negoro S">S Negoro</name></author><author><name sortKey="Inoue, T" uniqKey="Inoue T">T Inoue</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Santini, Fc" uniqKey="Santini F">FC Santini</name></author><author><name sortKey="Rizvi, H" uniqKey="Rizvi H">H Rizvi</name></author><author><name sortKey="Plodkowski, Aj" uniqKey="Plodkowski A">AJ Plodkowski</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Intern Med</journal-id><journal-id journal-id-type="iso-abbrev">Intern. Med</journal-id><journal-title-group><journal-title>Internal Medicine</journal-title></journal-title-group><issn pub-type="ppub">0918-2918</issn><issn pub-type="epub">1349-7235</issn><publisher><publisher-name>The Japanese Society of Internal Medicine</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31243239</article-id><article-id pub-id-type="pmc">6815895</article-id><article-id pub-id-type="doi">10.2169/internalmedicine.2556-19</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Tenosynovitis Induced by an Immune Checkpoint Inhibitor: A Case Report and Literature Review</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Murakami</surname><given-names>Shoko</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nagano</surname><given-names>Tatsuya</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nakata</surname><given-names>Kyosuke</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Onishi</surname><given-names>Akira</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Umezawa</surname><given-names>Kanoko</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Katsurada</surname><given-names>Naoko</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Yamamoto</surname><given-names>Masatsugu</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tachihara</surname><given-names>Motoko</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kobayashi</surname><given-names>Kazuyuki</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Nishimura</surname><given-names>Yoshihiro</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><aff id="aff1"><label>1</label>Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan</aff><aff id="aff2"><label>2</label>Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan</aff></contrib-group><author-notes><fn><p>Correspondence to Dr. Tatsuya Nagano, <email>tnagano@med.kobe-u.ac.jp</email></p></fn></author-notes><pub-date pub-type="epub"><day>27</day><month>6</month><year>2019</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>10</month><year>2019</year></pub-date><volume>58</volume><issue>19</issue><fpage>2839</fpage><lpage>2843</lpage><history><date date-type="received"><day>12</day><month>1</month><year>2019</year></date><date date-type="accepted"><day>14</day><month>4</month><year>2019</year></date></history><permissions><copyright-statement>Copyright © 2019 by The Japanese Society of Internal Medicine</copyright-statement><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">https://creativecommons.org/licenses/by-nc-nd/4.0/</ext-link>).</license-p></license></permissions><abstract><p>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. </p></abstract><kwd-group kwd-group-type="author"><kwd>tenosynovitis</kwd><kwd>pembrolizumab</kwd><kwd>prednisolone</kwd></kwd-group></article-meta></front><body><sec><title>Introduction</title><p>Immune checkpoint inhibitors (ICIs) are antibodies that target the primary immune surveillance escape mechanisms, i.e. the immune checkpoints. Immune checkpoints are involved in maintaining the homeostasis of immune responses and in the establishment of peripheral immune tolerance to self-antigens. Therefore, the failure of this tolerance causes autoimmune diseases (<xref rid="B1" ref-type="bibr">1</xref>).</p><p>Related adverse events (AEs) are called immune-related AEs (irAEs). Although it is thought that T cells are mainly involved in irAEs, B cells that produce antibodies and granulocytes that produce inflammatory cytokines are also thought to be involved (<xref rid="B1" ref-type="bibr">1</xref>-<xref rid="B4" ref-type="bibr">4</xref>). IrAEs commonly occur in the skin, gastrointestinal tract, liver, and endocrine system (<xref rid="B5" ref-type="bibr">5</xref>). However, irAEs can also occur in other areas, such as the kidneys, nerves, muscles, and lungs. The rate of arthralgia reported in clinical trials of ICIs has ranged from 1% to 43% (<xref rid="B6" ref-type="bibr">6</xref>). As tenosynovitis is only seen in a few case reports, its optimum management has yet to be established.</p><p>We herein report a patient who developed tenosynovitis induced by pembrolizumab and experienced a good response to systemic corticosteroid treatment while continuing pembrolizumab.</p></sec><sec><title>Case Report</title><p>In November 2017, a 51-year-old man was diagnosed with stage IIIB non-small cell lung cancer (NSCLC) lacking epidermal growth factor receptor (<italic>EGFR</italic>), anaplastic lymphoma kinase (<italic>ALK</italic>), and c-ros oncogene-1 (<italic>ROS-1</italic>) gene mutations. The expression of programmed cell death ligand-1 (PD-L1) was 20%. There was neither a medical history nor a family history of lung cancer or collagen-related diseases. The patient's vital signs were normal, and the Eastern Cooperative Oncology Group performance status (ECOG PS) score was 0.</p><p>Initially, the patient was treated with 4 cycles of cisplatin (60 mg/m<sup>2</sup>) on day 1 and TS-1 (120 mg/body) on days 1-21 concurrently with radiotherapy (60 Gy/30 fr). After four cycles of cisplatin and TS-1 chemotherapy, computed tomography (CT) revealed disease progression involving the right adrenal gland, although the primary tumor in the right upper lobe had shrunk (<xref ref-type="fig" rid="g001">Fig. 1A and D</xref>). Therefore, second-line treatment with pembrolizumab [200 mg every 3 weeks (q3w)] was introduced in May 2018.</p><fig id="g001" orientation="portrait" position="float"><label>Figure 1.</label><caption><p>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).</p></caption><graphic xlink:href="1349-7235-58-2839-g001"></graphic></fig><p>On day 2, after two cycles of pembrolizumab, the patient presented with edema with a Common Terminology Criteria for Adverse Events (CTCAE) grade of 1, which was limited to the left third, fourth, and fifth fingers and led to a poor function. Pembrolizumab was continued, and the edema was carefully observed. The patient gradually developed edema with pain in the interphalangeal joints and left wrist joint. On day 24, after three cycles of pembrolizumab, a venous echo-Doppler assessment showed no thrombi between the left subclavian vein and the left dorsal hand vein. Laboratory tests revealed negative results for rheumatoid factor, anti-cyclic citrullinated peptide (CCP) antibodies, anti-ribonucleoprotein (RNP) antibodies, anti-Smith (Sm) antibodies, anti-Sjögren's syndrome-related antigen-A (SS-A) antibodies, anti-dsDNA antibodies, anti-ssDNA antibodies, proteinase 3 (PR3)-anti-neutrophil cytoplasmic antibody (ANCA), and myeloperoxidase (MPO)-ANCA. However, the results for anti-nuclear antibodies were positive (80), and the C-reactive protein (CRP) level (0.33 mg/dL) and erythrocyte sedimentation rate (21 mm/h) were slightly elevated (<xref rid="t001" ref-type="table">Table 1</xref>).</p><table-wrap id="t001" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Summary of Laboratory Data.</p></caption><table frame="hsides" rules="groups"><tbody style="border-top:solid thin; border-bottom:solid thin;"><tr><td valign="top" rowspan="1" colspan="1">Hematology</td><td style="width:1em" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td style="width:1em" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td style="width:1em" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Creatinine (mg/dL)</td><td style="width:1em" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.74</td></tr><tr><td valign="top" rowspan="1" colspan="1">White blood cell (/µL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">11,300</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Glucose (mg/dL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">113</td></tr><tr><td valign="top" style="padding-left:1em;" rowspan="1" colspan="1">Neutropil (%)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">78</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Sodium (mmol/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">143</td></tr><tr><td valign="top" style="padding-left:1em;" rowspan="1" colspan="1">Eosinophil (%)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">1</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Potassium (mmol/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">3.9</td></tr><tr><td valign="top" style="padding-left:1em;" rowspan="1" colspan="1">Basophil (%)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">1</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Chloride (mmol/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">105</td></tr><tr><td valign="top" style="padding-left:1em;" rowspan="1" colspan="1">Monocyte (%)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">6</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Corrected calcium (mmol/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">9.5</td></tr><tr><td valign="top" style="padding-left:1em;" rowspan="1" colspan="1">Lymphocyte (%)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">14</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Serological examination</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td></tr><tr><td valign="top" rowspan="1" colspan="1">Red blood cell (/µL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">352×10<sup>4</sup></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">C-reactive protein (mg/dL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">3.16</td></tr><tr><td valign="top" rowspan="1" colspan="1">Hemoglobin (g/dL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">12</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">erythrocyte sedimentation rate (mm/h)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">21</td></tr><tr><td valign="top" rowspan="1" colspan="1">Hematocrit (%)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">35.6</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Antinuclear antibody</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">80</td></tr><tr><td valign="top" rowspan="1" colspan="1">Platelet (/µL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">214×10<sup>3</sup></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">Rheumatoid factor (IU/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><5</td></tr><tr><td valign="top" rowspan="1" colspan="1">Biochemistry</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">anti-cyclic citrullinated peptide antibodies (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.6</td></tr><tr><td valign="top" rowspan="1" colspan="1">Aspartate transaminase (U/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">22</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">anti-ribonucleoprotein antibodies (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">3.6</td></tr><tr><td valign="top" rowspan="1" colspan="1">Alanine transaminase (U/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">18</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">anti-Smith antibodies (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.8</td></tr><tr><td valign="top" rowspan="1" colspan="1">γ-glutamyl transpeptidase (U/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">82</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">anti-Sjögren’s syndrome-related antigen-A antibodies (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.3</td></tr><tr><td valign="top" rowspan="1" colspan="1">Alkaline phosphatase (U/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">470</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">anti-dsDNA antibodies (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">3.4</td></tr><tr><td valign="top" rowspan="1" colspan="1">Lactate dehydrogenase isozyme (IU/L)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">160</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">anti-ssDNA antibodies (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">7.8</td></tr><tr><td valign="top" rowspan="1" colspan="1">Total bilirubin (mg/dL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">proteinase 3-anti-neutrophil cytoplasmic antibody (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><0.1</td></tr><tr><td valign="top" rowspan="1" colspan="1">Blood urea nitrogen (mg/dL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">14</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" rowspan="1" colspan="1">myeloperoxidase-anti-neutrophil cytoplasmic antibody (U/mL)</td><td valign="top" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><0.1</td></tr></tbody></table></table-wrap><p>On day 15, after four cycles of pembrolizumab, contrast-enhanced magnetic resonance imaging (MRI) revealed that the left third, fourth, and fifth fingers and right first finger had become enlarged. Regarding the proximal and distal interphalangeal joints, there was low signal intensity on T1-weighted imaging (T1WI) and high signal intensity on T2-weighted imaging (T2WI), short-tau inversion-recovery (STIR) imaging, and gradient echo (GE) imaging (<xref ref-type="fig" rid="g002">Fig. 2</xref>). There was no erosion or joint space narrowing. In contrast, the CT scan on day 21, after four cycles of pembrolizumab, showed that the right upper lobe tumor and the right adrenal gland metastasis had shrunk [partial response based on Response Evaluation Criteria in Solid Tumor (RECIST) guidelines v1.1] (<xref ref-type="fig" rid="g001">Fig. 1B and E</xref>). On day 1, after five cycles of pembrolizumab, the patient had pain and stiffness in the left third, fourth, and fifth fingers and the left wrist when initiating movement. In addition, he had pain in his right thumb, bilateral knees, and ankles.</p><fig id="g002" orientation="portrait" position="float"><label>Figure 2.</label><caption><p>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).</p></caption><graphic xlink:href="1349-7235-58-2839-g002"></graphic></fig><p>Biological tests ruled out infectious agents, venous thrombosis, and rheumatoid arthritis. Based on the clinical, serologic, and imaging results, we diagnosed him with tenosynovitis. On day 1, after 5 cycles of pembrolizumab, we prescribed oral prednisolone (0.5 mg/kg/day, amounting to 20 mg/day), while pembrolizumab was continued. After prednisolone administration, the symptoms were relieved within 2 weeks (<xref ref-type="fig" rid="g003">Fig. 3</xref>). At 5 weeks after starting prednisolone, the prednisolone dose was tapered (0.375 mg/kg/day) because the patient developed significant facial swelling known as “moon face”. On day 21, after eight cycles of pembrolizumab, the tumor was continuing to shrink, and the partial response was continuing.</p><fig id="g003" orientation="portrait" position="float"><label>Figure 3.</label><caption><p>The clinical course of the patient.</p></caption><graphic xlink:href="1349-7235-58-2839-g003"></graphic></fig></sec><sec><title>Discussion</title><p>To our knowledge, this is a first case of tenosynovitis shown to be controlled with systemic corticosteroid treatment administered with continuous ICI use.</p><p>External stimuli over-activate innate immune cells, including neutrophils, macrophages, and γδT cells, and induce the production of pro-inflammatory cytokines, leading to tenosynovitis (<xref rid="B7" ref-type="bibr">7</xref>) and the systemic overexpression of interleukin (IL)-23 in B10. RIII mice shows severe paw swelling (<xref rid="B8" ref-type="bibr">8</xref>). SKG mice that have a gain-of-function mutation in T cell receptor protein ZAP 70 spontaneously develop tail vertebral disease as well as autoimmune inflammatory arthritis with high titers of autoimmune antibodies (<xref rid="B9" ref-type="bibr">9</xref>,<xref rid="B10" ref-type="bibr">10</xref>). This mouse model suggests the crucial role of the IL-17-IL23 axis in the pathogenesis of tenosynovitis. This immune pathway in the pathogenesis of tenosynovitis might be affected by ICI treatment.</p><p>A few case reports of tenosynovitis caused by ICIs have been reported (<xref rid="B11" ref-type="bibr">11</xref>-<xref rid="B14" ref-type="bibr">14</xref>). Although corticosteroid injection is generally used as the primary treatment modality in patients with tenosynovitis (<xref rid="B15" ref-type="bibr">15</xref>), as summarized in <xref rid="t002" ref-type="table">Table 2</xref>, oral corticosteroid is also effective for the improvement of tenosynovitis. In the current case, 20 mg/day prednisone improved the symptoms faster than other drugs, such as sulfasalazine (Salazopyrin), non-steroidal anti-inflammatory drugs (NSAIDs), and opioids.</p><table-wrap id="t002" orientation="portrait" position="float"><label>Table 2.</label><caption><p>Summary of Characteristics of the Patients with Tenosynovitis after Immune Checkpoint Inhibitor for Cancer.</p></caption><table frame="hsides" rules="groups"><thead style="border-top:solid thin; border-bottom:solid thin;"><tr><th valign="middle" align="center" style="width:3em" rowspan="1" colspan="1">Case</th><th valign="middle" align="center" style="width:4.5em" rowspan="1" colspan="1">Reference</th><th valign="middle" align="center" style="width:4em" rowspan="1" colspan="1">Sex</th><th valign="middle" align="center" style="width:2.5em" rowspan="1" colspan="1">Age, years</th><th valign="middle" align="center" style="width:5em" rowspan="1" colspan="1">Cancer type</th><th valign="middle" align="center" style="width:5em" rowspan="1" colspan="1">ICI</th><th valign="middle" align="center" style="width:10em" rowspan="1" colspan="1">Duration from ICI to tenosynovitis, months</th><th valign="middle" align="center" style="width:5.5em" rowspan="1" colspan="1">Site</th><th valign="middle" align="center" style="width:10.5em" rowspan="1" colspan="1">Treatment</th><th valign="middle" align="center" style="width:8em" rowspan="1" colspan="1">Tenosynovitis outcome</th><th valign="middle" align="center" style="width:11em" rowspan="1" colspan="1">Continuation or recommence of ICI</th><th valign="middle" align="center" style="width:6.5em" rowspan="1" colspan="1">Duration of ICI after tenosynovitis, months</th></tr></thead><tbody style="border-top:solid thin; border-bottom:solid thin;"><tr><td valign="top" align="center" rowspan="1" colspan="1">1</td><td valign="top" align="center" rowspan="1" colspan="1">(11)</td><td valign="top" align="center" rowspan="1" colspan="1">Male</td><td valign="top" align="center" rowspan="1" colspan="1">60</td><td valign="top" align="center" rowspan="1" colspan="1">Melanoma</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1</td><td valign="top" align="center" rowspan="1" colspan="1">19</td><td valign="top" align="center" rowspan="1" colspan="1">Wrist and forearm</td><td valign="top" align="center" rowspan="1" colspan="1">Pamidronate 90 mg, salazopyrin 2 g/d and opioid</td><td valign="top" align="center" rowspan="1" colspan="1">Improved</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td><td valign="top" align="center" rowspan="1" colspan="1">20</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">2</td><td valign="top" align="center" rowspan="1" colspan="1">(11)</td><td valign="top" align="center" rowspan="1" colspan="1">Female</td><td valign="top" align="center" rowspan="1" colspan="1">68</td><td valign="top" align="center" rowspan="1" colspan="1">Melanoma</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1</td><td valign="top" align="center" rowspan="1" colspan="1">12</td><td valign="top" align="center" rowspan="1" colspan="1">Wrist, forearm, and knee</td><td valign="top" align="center" rowspan="1" colspan="1">Naproxen 500 mg bid, hydroxychloroquine 200 mg/d, paracetamol 1g q6h and opioid</td><td valign="top" align="center" rowspan="1" colspan="1">Not resolved to grade 1 or less</td><td valign="top" align="center" rowspan="1" colspan="1">No</td><td valign="top" align="center" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">3</td><td valign="top" align="center" rowspan="1" colspan="1">(6)</td><td valign="top" align="center" rowspan="1" colspan="1">Female</td><td valign="top" align="center" rowspan="1" colspan="1">46</td><td valign="top" align="center" rowspan="1" colspan="1">Melanoma</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1 and CTLA-4</td><td valign="top" align="center" rowspan="1" colspan="1">13</td><td valign="top" align="center" rowspan="1" colspan="1">Wrists</td><td valign="top" align="center" rowspan="1" colspan="1">Infliximab and etanercept</td><td valign="top" align="center" rowspan="1" colspan="1">Improved</td><td valign="top" align="center" rowspan="1" colspan="1">Not available</td><td valign="top" align="center" rowspan="1" colspan="1">Not available</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">(13)</td><td valign="top" align="center" rowspan="1" colspan="1">Male</td><td valign="top" align="center" rowspan="1" colspan="1">57</td><td valign="top" align="center" rowspan="1" colspan="1">NSCLC</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1 and CTLA-4</td><td valign="top" align="center" rowspan="1" colspan="1">11</td><td valign="top" align="center" rowspan="1" colspan="1">Wrists</td><td valign="top" align="center" rowspan="1" colspan="1">Prednisone 10 mg/d and tendon sheath injection</td><td valign="top" align="center" rowspan="1" colspan="1">Not resolved until stopping ICI</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td><td valign="top" align="center" rowspan="1" colspan="1">9</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">5</td><td valign="top" align="center" rowspan="1" colspan="1">(13)</td><td valign="top" align="center" rowspan="1" colspan="1">Female</td><td valign="top" align="center" rowspan="1" colspan="1">74</td><td valign="top" align="center" rowspan="1" colspan="1">Melanoma</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1</td><td valign="top" align="center" rowspan="1" colspan="1">4</td><td valign="top" align="center" rowspan="1" colspan="1">Wrist and shoulder</td><td valign="top" align="center" rowspan="1" colspan="1">Prednisone 10 mg/d and intraarticular steroid injection</td><td valign="top" align="center" rowspan="1" colspan="1">Not resolved until stopping ICI</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td><td valign="top" align="center" rowspan="1" colspan="1">10</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">6</td><td valign="top" align="center" rowspan="1" colspan="1">(14)</td><td valign="top" align="center" rowspan="1" colspan="1">Female</td><td valign="top" align="center" rowspan="1" colspan="1">56</td><td valign="top" align="center" rowspan="1" colspan="1">NSCLC</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1</td><td valign="top" align="center" rowspan="1" colspan="1">5</td><td valign="top" align="center" rowspan="1" colspan="1">MCPs and wrists</td><td valign="top" align="center" rowspan="1" colspan="1">Opioids</td><td valign="top" align="center" rowspan="1" colspan="1">Improved within 6 months</td><td valign="top" align="center" rowspan="1" colspan="1">Not available</td><td valign="top" align="center" rowspan="1" colspan="1">Not available</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">7</td><td valign="top" align="center" rowspan="1" colspan="1">(14)</td><td valign="top" align="center" rowspan="1" colspan="1">Male</td><td valign="top" align="center" rowspan="1" colspan="1">61</td><td valign="top" align="center" rowspan="1" colspan="1">NSCLC</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1</td><td valign="top" align="center" rowspan="1" colspan="1">1</td><td valign="top" align="center" rowspan="1" colspan="1">Fingers</td><td valign="top" align="center" rowspan="1" colspan="1">NSAIDs</td><td valign="top" align="center" rowspan="1" colspan="1">Improved within 6 months</td><td valign="top" align="center" rowspan="1" colspan="1">Not available</td><td valign="top" align="center" rowspan="1" colspan="1">Not available</td></tr><tr><td valign="top" align="center" rowspan="1" colspan="1">9</td><td valign="top" align="center" rowspan="1" colspan="1">Present case</td><td valign="top" align="center" rowspan="1" colspan="1">Male</td><td valign="top" align="center" rowspan="1" colspan="1">51</td><td valign="top" align="center" rowspan="1" colspan="1">NSCLC</td><td valign="top" align="center" rowspan="1" colspan="1">PD-1</td><td valign="top" align="center" rowspan="1" colspan="1">1</td><td valign="top" align="center" rowspan="1" colspan="1">Fingers</td><td valign="top" align="center" rowspan="1" colspan="1">Prednisone 20 mg/d</td><td valign="top" align="center" rowspan="1" colspan="1">Improved within 2 weeks</td><td valign="top" align="center" rowspan="1" colspan="1">Yes</td><td valign="top" align="center" rowspan="1" colspan="1">3</td></tr></tbody></table><table-wrap-foot><fn><p>ICI: immune checkpoint inhibitor, PD-1: programmed cell death 1, CTLA-4: cytotoxic T-lymphocyte-associated protein 4, NSCLC: non-small cell lung cancer, MCP: metacarpophalangeal, NSAIDs: non-steroidal anti-inflammatory drugs, PD-L1: programmed cell death 1 ligand</p></fn></table-wrap-foot></table-wrap><p>Arbour et al. reported that, in 2 independent cohorts of NSCLC patients, baseline corticosteroid treatment (involving ≥10 mg/day prednisone equivalent), most commonly for dyspnea (33%), fatigue (21%), or brain metastases (19%), was associated with a significantly decreased progression-free survival and overall survival (<xref rid="B16" ref-type="bibr">16</xref>). In addition, a multivariate analysis of the pooled population confirmed that baseline corticosteroid treatment was significantly associated with a decreased progression-free survival (hazard ratio, 1.3; p=0.03) and overall survival (hazard ratio, 1.7; p<0.001) (<xref rid="B16" ref-type="bibr">16</xref>). They also reported that six patients who experienced a partial response to ICI therapy in combination with corticosteroid had nothing in common other than a PS of 1. In general, corticosteroid tends to be prescribed to patients who have a PS ≥2 and a poor prognosis, but the confounding factors of that multivariate analysis (smoking history, PS, brain metastasis) were not clearly indicated. In addition, the results of the univariate analysis are also not shown. As such, a PS ≥2 might be a fundamental prognostic indicator, while there may also be other factors influencing the results.</p><p>Whether or not corticosteroid at the beginning of ICI administration directly affects the outcome of ICI treatment remains controversial. Indeed, corticosteroids are also used for the management of irAEs, and corticosteroid use in this context has not been associated with a decreased efficacy of ICIs in either melanoma (<xref rid="B17" ref-type="bibr">17</xref>,<xref rid="B18" ref-type="bibr">18</xref>) or NSCLC (<xref rid="B19" ref-type="bibr">19</xref>). In addition, previous studies have shown that resuming ICIs did not affect the survival after irAE-related cessation, especially in cases with a partial response (<xref rid="B20" ref-type="bibr">20</xref>,<xref rid="B21" ref-type="bibr">21</xref>). These findings suggest that, if irAEs occur, there is no need for responders to continue ICI use; however, continuing ICIs is still a viable treatment option in cases with stable disease.</p><sec><title>Conclusion</title><p>In this case report, we described for the first time the successful management of ICI-induced tenosynovitis while continuing ICI use, suggesting that 0.5 mg/kg/day systemic prednisone might be effective for treating tenosynovitis without requiring ICI cessation.</p></sec></sec><sec sec-type="COI-statement"><title></title><p><bold>The authors state that they have no Conflict of Interest (COI).</bold></p></sec></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Haanen</surname><given-names>JB</given-names></name>, <name><surname>Thienen</surname><given-names>H</given-names></name>, <name><surname>Blank</surname><given-names>CU</given-names></name></person-group><article-title>Toxicity patterns with immunomodulating antibodies and their combinations</article-title>. <source>Semin Oncol</source><volume>42</volume>: <fpage>423</fpage>-<lpage>428</lpage>, <year>2015</year>.<pub-id pub-id-type="pmid">25965360</pub-id></mixed-citation></ref><ref id="B2"><label>2.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Good-Jacobson</surname><given-names>KL</given-names></name>, <name><surname>Szumilas</surname><given-names>CG</given-names></name>, <name><surname>Chen</surname><given-names>L</given-names></name>, <name><surname>Sharpe</surname><given-names>AH</given-names></name>, <name><surname>Tomayko</surname><given-names>MM</given-names></name>, <name><surname>Shlomchik</surname><given-names>MJ</given-names></name></person-group><article-title>PD-1 regulates germinal center B cell survival and the formation and affinity of long-lived plasma cells</article-title>. <source>Nat Immunol</source><volume>11</volume>: <fpage>535</fpage>-<lpage>542</lpage>, <year>2010</year>.<pub-id pub-id-type="pmid">20453843</pub-id></mixed-citation></ref><ref id="B3"><label>3.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zitvogel</surname><given-names>L</given-names></name>, <name><surname>Kroemer</surname><given-names>G</given-names></name></person-group><article-title>Targeting PD-1/PD-L1 interactions for cancer immunotherapy</article-title>. <source>Oncoimmunology</source><volume>1</volume>: <fpage>1223</fpage>-<lpage>1225</lpage>, <year>2012</year>.<pub-id pub-id-type="pmid">23243584</pub-id></mixed-citation></ref><ref id="B4"><label>4.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Iwama</surname><given-names>S</given-names></name>, <name><surname>De Remigis</surname><given-names>A</given-names></name>, <name><surname>Callahan</surname><given-names>MK</given-names></name>, <name><surname>Slovin</surname><given-names>SF</given-names></name>, <name><surname>Wolchok</surname><given-names>JD</given-names></name>, <name><surname>Caturegli</surname><given-names>P</given-names></name></person-group><article-title>Pituitary expression of CTLA-4 mediates hypophysitis secondary to administration of CTLA-4 blocking antibody</article-title>. <source>Sci Transl Med</source><volume>6</volume>: <fpage>230ra245</fpage>, <year>2014</year>.</mixed-citation></ref><ref id="B5"><label>5.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Postow</surname><given-names>MA</given-names></name>, <name><surname>Sidlow</surname><given-names>R</given-names></name>, <name><surname>Hellmann</surname><given-names>MD</given-names></name></person-group><article-title>Immune-related adverse events associated with immune checkpoint blockade</article-title>. <source>N Engl J Med</source><volume>378</volume>: <fpage>158</fpage>-<lpage>168</lpage>, <year>2018</year>.<pub-id pub-id-type="pmid">29320654</pub-id></mixed-citation></ref><ref id="B6"><label>6.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cappelli</surname><given-names>LC</given-names></name>, <name><surname>Gutierrez</surname><given-names>AK</given-names></name>, <name><surname>Bingham</surname><given-names>CO</given-names></name>, <name><surname>Shah</surname><given-names>AA</given-names></name></person-group><article-title>Rheumatic and musculoskeletal immune-related adverse events due to immune checkpoint inhibitors: a systematic review of the literature</article-title>. <source>Arthritis Care Res (Hoboken)</source><volume>69</volume>: <fpage>1751</fpage>-<lpage>1763</lpage>, <year>2017</year>.<pub-id pub-id-type="pmid">27998041</pub-id></mixed-citation></ref><ref id="B7"><label>7.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McGonagle</surname><given-names>D</given-names></name>, <name><surname>Tan</surname><given-names>AL</given-names></name>, <name><surname>Watad</surname><given-names>A</given-names></name>, <name><surname>Helliwell</surname><given-names>P</given-names></name></person-group><article-title>Pathophysiology, assessment and treatment of psoriatic dactylitis</article-title>. <source>Nat Rev Rheumatol</source><volume>15</volume>: <fpage>113</fpage>-<lpage>122</lpage>, <year>2019</year>.<pub-id pub-id-type="pmid">30610219</pub-id></mixed-citation></ref><ref id="B8"><label>8.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sherlock</surname><given-names>JP</given-names></name>, <name><surname>Joyce-Shaikh</surname><given-names>B</given-names></name>, <name><surname>Turner</surname><given-names>SP</given-names></name>, <etal>et al</etal></person-group><article-title>IL-23 induces spondyloarthropathy by acting on ROR-γt+ CD3+CD4-CD8- entheseal resident T cells</article-title>. <source>Nat Med</source><volume>18</volume>: <fpage>1069</fpage>-<lpage>1076</lpage>, <year>2012</year>.<pub-id pub-id-type="pmid">22772566</pub-id></mixed-citation></ref><ref id="B9"><label>9.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sakaguchi</surname><given-names>N</given-names></name>, <name><surname>Takahashi</surname><given-names>T</given-names></name>, <name><surname>Hata</surname><given-names>H</given-names></name>, <etal>et al</etal></person-group><article-title>Altered thymic T-cell selection due to a mutation of the ZAP-70 gene causes autoimmune arthritis in mice</article-title>. <source>Nature</source><volume>426</volume>: <fpage>454</fpage>-<lpage>460</lpage>, <year>2003</year>.<pub-id pub-id-type="pmid">14647385</pub-id></mixed-citation></ref><ref id="B10"><label>10.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vieira-Sousa</surname><given-names>E</given-names></name>, <name><surname>van Duivenvoorde</surname><given-names>LM</given-names></name>, <name><surname>Fonseca</surname><given-names>JE</given-names></name>, <name><surname>Lories</surname><given-names>RJ</given-names></name>, <name><surname>Baeten</surname><given-names>DL</given-names></name></person-group><article-title>Review: animal models as a tool to dissect pivotal pathways driving spondyloarthritis</article-title>. <source>Arthritis Rheumatol</source><volume>67</volume>: <fpage>2813</fpage>-<lpage>2827</lpage>, <year>2015</year>.<pub-id pub-id-type="pmid">26215401</pub-id></mixed-citation></ref><ref id="B11"><label>11.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>MM</given-names></name>, <name><surname>Kefford</surname><given-names>RF</given-names></name>, <name><surname>Carlino</surname><given-names>M</given-names></name>, <name><surname>Clements</surname><given-names>A</given-names></name>, <name><surname>Manolios</surname><given-names>N</given-names></name></person-group><article-title>Arthritis and tenosynovitis associated with the anti-PD1 antibody pembrolizumab in metastatic melanoma</article-title>. <source>J Immunother</source><volume>38</volume>: <fpage>37</fpage>-<lpage>39</lpage>, <year>2015</year>.<pub-id pub-id-type="pmid">25415286</pub-id></mixed-citation></ref><ref id="B12"><label>12.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cappelli</surname><given-names>LC</given-names></name>, <name><surname>Gutierrez</surname><given-names>AK</given-names></name>, <name><surname>Baer</surname><given-names>AN</given-names></name>, <etal>et al</etal></person-group><article-title>Inflammatory arthritis and sicca syndrome induced by nivolumab and ipilimumab</article-title>. <source>Ann Rheum Dis</source><volume>76</volume>: <fpage>43</fpage>-<lpage>50</lpage>, <year>2017</year>.<pub-id pub-id-type="pmid">27307501</pub-id></mixed-citation></ref><ref id="B13"><label>13.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Smith</surname><given-names>MH</given-names></name>, <name><surname>Bass</surname><given-names>AR</given-names></name></person-group><article-title>Arthritis after cancer immunotherapy: symptom duration and treatment response</article-title>. <source>Arthritis Care Res (Hoboken)</source><volume>71</volume>: <fpage>362</fpage>-<lpage>366</lpage>, <year>2019</year>.<pub-id pub-id-type="pmid">29125905</pub-id></mixed-citation></ref><ref id="B14"><label>14.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Inamo</surname><given-names>J</given-names></name>, <name><surname>Kaneko</surname><given-names>Y</given-names></name>, <name><surname>Takeuchi</surname><given-names>T</given-names></name></person-group><article-title>Inflammatory tenosynovitis and enthesitis induced by immune checkpoint inhibitor treatment</article-title>. <source>Clin Rheumatol</source><volume>37</volume>: <fpage>1107</fpage>-<lpage>1110</lpage>, <year>2018</year>.<pub-id pub-id-type="pmid">29455266</pub-id></mixed-citation></ref><ref id="B15"><label>15.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Blood</surname><given-names>TD</given-names></name>, <name><surname>Morrell</surname><given-names>NT</given-names></name>, <name><surname>Weiss</surname><given-names>AP</given-names></name></person-group><article-title>Tenosynovitis of the hand and wrist: a critical analysis review</article-title>. <source>JBJS Rev</source><fpage>4</fpage>, <year>2016</year>.</mixed-citation></ref><ref id="B16"><label>16.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Arbour</surname><given-names>KC</given-names></name>, <name><surname>Mezquita</surname><given-names>L</given-names></name>, <name><surname>Long</surname><given-names>N</given-names></name>, <etal>et al</etal></person-group><article-title>Impact of baseline steroids on efficacy of programmed cell death-1 and programmed death-ligand 1 blockade in patients with non-small-cell lung cancer</article-title>. <source>J Clin Oncol</source><volume>36</volume>: <fpage>2872</fpage>-<lpage>2878</lpage>, <year>2018</year>.<pub-id pub-id-type="pmid">30125216</pub-id></mixed-citation></ref><ref id="B17"><label>17.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Horvat</surname><given-names>TZ</given-names></name>, <name><surname>Adel</surname><given-names>NG</given-names></name>, <name><surname>Dang</surname><given-names>TO</given-names></name>, <etal>et al</etal></person-group><article-title>Immune-related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment gailure in patients with melanoma treated with ipilimumab at memorial sloan kettering cancer center</article-title>. <source>J Clin Oncol</source><volume>33</volume>: <fpage>3193</fpage>-<lpage>3198</lpage>, <year>2015</year>.<pub-id pub-id-type="pmid">26282644</pub-id></mixed-citation></ref><ref id="B18"><label>18.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Weber</surname><given-names>JS</given-names></name>, <name><surname>Larkin</surname><given-names>JMG</given-names></name>, <name><surname>Schadendorf</surname><given-names>D</given-names></name>, <etal>et al</etal></person-group><article-title>Management of gastrointestinal (GI) toxicity associated with nivolumab (NIVO) plus ipilimumab (IPI) or IPI alone in phase II and III trials in advanced melanoma (MEL)</article-title>. <source>J Clin Oncol</source><volume>35</volume>: <fpage>9523</fpage>, <year>2017</year>.</mixed-citation></ref><ref id="B19"><label>19.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Santini</surname><given-names>FC</given-names></name>, <name><surname>Rizvi</surname><given-names>H</given-names></name>, <name><surname>Wilkins</surname><given-names>O</given-names></name>, <etal>et al</etal></person-group><article-title>Safety of retreatment with immunotherapy after immune-related toxicity in patients with lung cancers treated with anti-PD(L)-1 therapy</article-title>. <source>J Clin Oncol</source><volume>35</volume>: <fpage>9012</fpage>, <year>2017</year>.</mixed-citation></ref><ref id="B20"><label>20.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tachihara</surname><given-names>M</given-names></name>, <name><surname>Negoro</surname><given-names>S</given-names></name>, <name><surname>Inoue</surname><given-names>T</given-names></name>, <etal>et al</etal></person-group><article-title>Efficacy of anti-PD-1/PD-L1 antibodies after discontinuation due to adverse events in non-small cell lung cancer patients (HANSHIN 0316)</article-title>. <source>BMC Cancer</source><volume>18</volume>: <fpage>946</fpage>, <year>2018</year>.<pub-id pub-id-type="pmid">30285770</pub-id></mixed-citation></ref><ref id="B21"><label>21.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Santini</surname><given-names>FC</given-names></name>, <name><surname>Rizvi</surname><given-names>H</given-names></name>, <name><surname>Plodkowski</surname><given-names>AJ</given-names></name>, <etal>et al</etal></person-group><article-title>Safety and efficacy of re-treating with immunotherapy after immune-related adverse events in patients with NSCLC</article-title>. <source>Cancer Immunol Res</source><volume>6</volume>: <fpage>1093</fpage>-<lpage>1099</lpage>, <year>2018</year>.<pub-id pub-id-type="pmid">29991499</pub-id></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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