Antibiotics/antineoplastics/steroids
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Various toxicities: 3 case reports In a retrospective study involving 1144 cancer patients conducted at a hospital in South-Korea between July 2014 and December 2018, 3 patients (2 men, 1 woman) aged 59–79 years were described who developed thyroiditis, membranous glomerulonephritis or tuberculosis (TB) during treatment with nivolumab, pembrolizumab, dexamethasone or prednisolone for the cancer. Additionally, one of these 3 patients, developed DRESS syndrome while receiving antitubercular therapy with isoniazid, rifampicin, ethambutol and pyrazinamide [not all routes and duration of treatments to reactions onsets stated; outcomes not stated]. Patient 1: A 63-year-old man with lung adenocarcinoma, started receiving treatment with IV nivolumab 3 mg/kg every 2 weeks (lymphocyte count of 1880 /mcgL). Previous treatments included three rounds of unspecified chemotherapy. Subsequently, he achieved partial response. However, after 20 months of treatment, he developed nivolumab-induced thyroiditis. At 22 months of treatment (41 cycles of treatment), bronchoalveolar lavage fluid culture showed positive result for Mycobacterium tuberculosis, and he was diagnosed with TB (lymphocyte count of 2089 /mcgL). Radiological findings demonstrated pneumonic consolidation in the right upper lobe without any cavity and no change of primary tumour in left upper lobe. Consequently, he started receiving antitubercular treatment with isoniazid, rifampicin, pyrazinamide and ethambutol; however, he developed DRESS syndrome. His nivolumab therapy was continued. Patient 2: A 79-year-old man with lung squamous cell carcinoma, started receiving treatment with IV pembrolizumab 2 mg/kg to a maximum of 200mg every 3 weeks (lymphocyte count of 1448 /mcgL). Previous treatments included one round of unspecified chemotherapy. Subsequently, the disease stabilised. However, at 7 months of treatment, he developed pembrolizumab-induced thyroiditis, and biopsy proven membranous glomerulonephritis at 11 months of treatment. For membranous glomerulonephritis, he received treatment with oral prednisolone 30mg once daily for one month. At 14 months of treatment (14 cycles of treatment), Xpert MTB/RIF assay of sputum confirmed the presence of Mycobacterium tuberculosis, and he was diagnosed with TB (lymphocyte count of 30 /mcgL). Radiological findings demonstrated air-fluid level and wall thickening of bullae in left upper lobe, and no change of primary tumour in right middle lobe. Consequently, he started receiving antitubercular treatment with isoniazid, rifampicin, pyrazinamide and ethambutol. However, he died due to peritonitis [aetiology unknown] at 14 months of pembrolizumab therapy. Patient 3: A 59-year-old woman with lung adenocarcinoma, started receiving treatment with IV nivolumab 3 mg/kg every 2 weeks. Previous treatments included six rounds of unspecified chemotherapy. After one cycle of nivolumab, continued progression of disease was noted. Hence, the treatment was changed to unspecified chemotherapy. Additionally, at 2 months after the start of
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