Japanese

Title	ニボルマブ + イピリムマブ療法中にサイトカイン放出症候群を繰り返し, 再燃の契機として細菌感染症が疑われた1例
Subtitle	CASE REPORT
Authors	松浦啓吾1,2, 角俊行1,2, 藤森賢人3, 鎌田弘毅2,3, 小林智史2,3, 大塚満雄2,3, 石郷岡大樹1,2, 池田拓海1,2, 山田裕一1,2, 千葉弘文2
Authors (kana)
Organization	1函館五稜郭病院呼吸器内科, 2札幌医科大学医学部呼吸器・アレルギー内科, 3札幌厚生病院呼吸器内科
Journal	肺癌
Volume	65
Number	1
Page	54-59
Year/Month	2025 /
Article	報告
Publisher	日本肺癌学会
Abstract	「要旨」 「背景.」 免疫チェックポイント阻害薬(immune checkpoint inhibitor: ICI)による重篤な免疫関連有害事象(immune-related adverse event: irAE)の一つにサイトカイン放出症候群(cytokine releasing syndrome: CRS)がある. これまでCRSの再燃について報告があるが, 再燃のリスクや重症度については明らかではない. 「症例.」 75歳, 男性. 肺腺癌術後の経過観察中に胸膜播種と癌性胸水が出現したため, ニボルマブ+イピリムマブ療法を開始した. Day 16に癌性胸水に対するドレナージ目的に入院した. Day 24より発熱し, day 35に強直間代性痙攣と低酸素血症を認めた. CRSと判断し, ステロイドパルスとトシリズマブの投与を行った. 状態は改善しday 72に退院した. Day 75より発熱と下腿部痛があり, 蜂窩織炎を契機としたCRSの再燃が疑われたためday78に再入院した. ステロイドや抗菌薬を投与したが改善なく死亡した. 「結論.」 CRSが再燃した要因として細菌感染症が考えられた. CRSの治療中は, 軽度の細菌感染であってもCRS発症の契機となる可能性があり, 速やかな治療介入と慎重な経過観察が求められる.
Practice	臨床医学：一般
Keywords	ニボルマブ, イピリムマブ, サイトカイン放出症候群, 細菌感染症, Nivolumab, Ipilimumab, Cytokine releasing syndrome, Bacterial infection

English

Title	A Case of Repeated Cytokine Releasing Syndrome During Nivolumab Plus Ipilimumab Therapy, with Bacterial Infection Suspected as a Trigger for Relapse
Subtitle	CASE REPORT
Authors	Keigo Matsuura1,2, Toshiyuki Sumi1,2, Kento Fujimori3, Kouki Kamada2,3, Tomofumi Kobayashi2,3, Mitsuo Otsuka2,3, Taiki Ishigooka1,2, Takumi Ikeda1,2, Yuichi Yamada1,2, Hirofumi Chiba2
Authors (kana)
Organization	1Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 2Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, 3Department of Respiratory Medicine, Hokkaido P.W.F.A.C. Sapporo-Kosei General Hospital
Journal	Japanese Journal of Lung Cancer
Volume	65
Number	1
Page	54-59
Year/Month	2025 /
Article	Report
Publisher	The Japanese Lung Cancer Society
Abstract	[ABSTRACT] [Background.] Cytokine releasing syndrome (CRS) is a severe immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICIs). Although there have been reports of CRS recurrence, the risk factors for recurrence and factors that predict its severity remain unclear. [Case report.] A 75-year-old male was under postoperative surveillance for lung adenocarcinoma when pleural dissemination and malignant pleural effusion were detected. He was started on nivolumab and ipilimumab therapy. On day 16, he was admitted for drainage of the malignant pleural effusion. From day 24, he developed a fever, and on day 35, he experienced tonic-clonic seizures and hypoxemia. He was diagnosed with CRS and treated with steroid pulse therapy and tocilizumab, resulting in improvement, and he was discharged on day 72. However, on day 75, he developed fever and lower leg pain, and recurrent CRS triggered by cellulitis was suspected, leading to readmission on day 78. Despite treatment with steroids and antibiotics, his condition did not improve, and he subsequently died. [Conclusion.] Bacterial infection was considered a potential factor in the recurrence of CRS. During CRS treatment, even mild bacterial infections may trigger CRS onset, highlighting the need for prompt therapeutic intervention and careful monitoring.
Practice	Clinical medicine
Keywords	Nivolumab, Ipilimumab, Cytokine releasing syndrome, Bacterial infection

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