Previously published and current case of Immune checkpoint inhibitor-related acral vasculitis. Patient characteristics
| Age/Gender | Cancer | ICI | Onset* | Skin lesions | Systemic symptoms | Immunological findings | CTCAE | Treatment/outcome of the IRAE | |
|---|---|---|---|---|---|---|---|---|---|
| Comont et al. | 66/Male | Urothelial bladder cancer | Anti-CTLA4 (tremelimumab)Anti-PDL1 (durvalumab) | 8 | Periungual skin necrosis of several digits of both hands | None | ANAs (titer 5200, speckled pattern) | 3 | ICI discontinuation; Prednisone Complete resolution of IRAE |
| Padda er al. | 52/Male | Melanoma | Anti-CTLA4 (ipilimumab) | 4 | Subungual necrosis on several upper and lower limb digits, rash | Myalgias, arthralgias, vision changes, jaw pain, interstitial pneumonia | None | 3 | ICI discontinuation; Methylprednisolone, prednisone, calcium channel blockers, nitropaste, poprostenol, botulinum toxin, sildenafil, rituximabWorsening of the IRAE requiring surgical amputation of multiple distal digits |
| Leburel et al. | 60/Male | Melanoma | Anti-PDL1 (UKN)BRAF and MEK inhibitors (UKN) | 8 | Necrosis of 3 fingers and the heels | Arthralgia, dry mouth, paresthaesia of the feet and interstitial pneumonia | ANAs (titer 160, speckled pattern), Anti-SSA AbsType III cryoglobulinemia | 3 | ICI discontinued; prednisone, calcium channel blockers, iloprost and acetylsalicylic acidPartial resolution of th.e IRAE |
| Gambichler et al. | 60/Male | Melanoma | Anti-PD1 (nivolumab)Anti- CTLA4 (ipilimumab) | 3 | Subungual necrosis on the fingertips of both hands, severe gangrene | None | None | 4 | ICI discontinued after a second course of nivolumab;Prostacyclin, methylprednisolone Worsening of the IRAE requiring surgical amputation of multiple distal digitsProgression of metastatic disease to multi-organ failure, leading to the death of the patient |
*Weeks between initiation of immunotherapy and the diagnosis of vasculitis
Ab antibodies, ANA antinuclear antibody, CTCAE Common Terminology Criteria for Adverse Events, ICI immune checkpoint inhibitor, IRAE immune-related adverse event, UKN unknown