• PDF / 151,551 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 21 Downloads / 171 Views

DOWNLOAD

REPORT

---

1 S

Acrocyanosis: case report A 55-year-old woman developed acrocyanosis during treatment with ipilimumab and nivolumab for stage III melanoma with inguinal lymph node metastasis. The woman had a history of stage III melanoma with an inguinal lymph node metastasis originating from a primary melanoma on her right calf. She received 2 cycles of neoadjuvant nivolumab 3 mg/kg infusion and ipilimumab 1 mg/kg infusion, as a part of a clinical trial. After 6 weeks, she underwent excision of the lymph node metastasis and achieved a complete pathological remission. However, 2 months after receiving the most recent nivolumab and ipilimumab administration, she developed paresthesia in her right index finger. Within 10 days, her symptoms worsened gradually, along with episodes of blue discolouration similar to the Raynaud phenomenon to persisting acrocyanosis in both hands. The woman was treated with prednisolone and nifedipine based on the suspicion of an immune-related adverse event. Further, a skin biopsy of her right index finger showed no abnormalities. However, her symptoms worsened and prednisolone treatment was intensified. After 1 week, she developed additional splinter bleeds at the nail folds. Hence, nifedipine dose was increased. Owing to the lack of clinical response, prednisolone dosage was tapered. Her finger pain progressed and she was started on aspirin and mycophenolate mofetil. After 10 days, tacrolimus was added to her treatment. A skin area and another papercut wound revealed necrotic tissue. To avoid further ischaemia, she was admitted for iloprost treatment, while continuing immunosuppression. After receiving iloprost for 5 days, the wounds slowly recovered. After 3 weeks, her symptoms had strongly improved. Nailfold capillaroscopy showed no abnormalities. Later, acrocyanosis and wounds completely recovered, whereas, mild pain in her fingers was noted for 16 weeks. Reijers ILM, et al. Acrocyanosis after neoadjuvant ipilimumab plus nivolumab: A case report. Clinical and Experimental Rheumatology 38: 1031-1032, No. 5, Sep 2020. 803518619 Available from: URL: https://www.clinexprheumatol.org/abstract.asp?a=14853

0114-9954/20/1833-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 5 Dec 2020 No. 1833