Pembrolizumab-induced Autoimmune Hemolytic Anemia and Hemophagocytic Lymphohistiocytosis in Non-small Cell Lung Cancer

Sachi Okawa; Hiroe Kayatani; Keiichi Fujiwara; Taichi Ozeki; Kenji Takada; Yoshitaka Iwamoto; Daisuke Minami; Ken Sato; Takuo Shibayama

doi:10.2169/internalmedicine.1001-18

CASE REPORTS

Pembrolizumab-induced Autoimmune Hemolytic Anemia and Hemophagocytic Lymphohistiocytosis in Non-small Cell Lung Cancer

Sachi Okawa, Hiroe Kayatani, Keiichi Fujiwara, Taichi Ozeki, Kenji Takada, Yoshitaka Iwamoto, Daisuke Minami, Ken Sato, Takuo Shibayama

Author information

Sachi Okawa
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Hiroe Kayatani
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Keiichi Fujiwara
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Taichi Ozeki
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Kenji Takada
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Yoshitaka Iwamoto
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Daisuke Minami
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Ken Sato
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Takuo Shibayama
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan

Keywords: pembrolizumab, immune checkpoint inhibitors, non-small cell lung cancer, autoimmune hemolytic anemia, hemophagocytic lymphohistiocytosis

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 5 Pages 699-702

DOI https://doi.org/10.2169/internalmedicine.1001-18

Details

Abstract

We herein report a 78-year old man with squamous cell carcinoma of the lungs treated with pembrolizumab. At 10 days after the administration of pembrolizumab, he showed progressive anemia and increased levels of bilirubin. Because the findings of a direct coombs test and cold hemagglutinin were positive, we diagnosed the patient with autoimmune hemolytic anemia and treated him with prednisolone. Subsequently, he was admitted to our hospital owing to fatigue, a high fever, and jaundice. His clinical findings met the diagnostic criteria of hemophagocytic lymphohistiocytosis, and he was rescued with a high dose of glucocorticoids. Marked tumor regression was obtained and has been maintained since then.

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