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

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

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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Fingers / diagnostic imaging
  • Glucocorticoids / therapeutic use
  • Humans
  • Lung Neoplasms / drug therapy
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prednisolone / therapeutic use
  • Tenosynovitis / chemically induced*
  • Tenosynovitis / diagnosis
  • Tenosynovitis / drug therapy

Substances

  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Agents, Immunological
  • Glucocorticoids
  • Prednisolone
  • pembrolizumab