Management of respiratory failure in immune checkpoint inhibitors-induced overlap syndrome: a case series and review of the literature

BMC Anesthesiology

Case Report

Cezar A. Iliescu¹  Robert Wegner²  Joshua Botdorf²  Dereddi R. Reddy²  John A. Cuenca²  Joseph L. Nates²  Sudhakar Tummala³  Ankit Hanmandlu⁴ 

[1] Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;Department of Critical Care Medicine, Division of Anesthesiology, Critical Care, and Pain, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., 77030, Houston, TX, USA;Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;McGovern School of Medicine, University of Texas, Houston, TX, USA;

关键词: Critical care;    Immune checkpoint inhibitor;    Immunotherapy;    Myasthenia gravis;    Myocarditis;    Myositis;    Oncology;   

DOI  :  10.1186/s12871-023-02257-z

 received in 2022-11-09, accepted in 2023-08-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCheckpoint inhibitor-induced overlap syndrome ([OS] myocarditis, and myositis with or without myasthenia gravis) is rare but life-threatening.Cases presentationHere we present a case series of four cancer patients that developed OS. High troponinemia raised the concern for myocarditis in all the cases. However, the predominant clinical feature differed among the cases. Two patients showed marked myocarditis with a shorter hospital stay. The other two patients had a prolonged ICU stay due to severe neuromuscular involvement secondary to myositis and myasthenia gravis. Treatment was based on steroids, plasmapheresis, intravenous immunoglobulin, and immunosuppressive biological agents.ConclusionThe management of respiratory failure is challenging, particularly in those patients with predominant MG. Along with intensive clinical monitoring, bedside respiratory mechanics can guide the decision-making process of selecting a respiratory support method, the timing of elective intubation and extubation.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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