Radiological imaging features of the salivary glands in xerostomia induced by an immune checkpoint inhibitor
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CASE REPORT
Radiological imaging features of the salivary glands in xerostomia induced by an immune checkpoint inhibitor Kouji Katsura1,5 · Saori Funayama2 · Kayoko Ito2 · Kaname Nohno3 · Noboru Kaneko4 · Masaki Takamura5 · Marie Soga1 · Taichi Kobayashi1 · Takafumi Hayashi1,5 Received: 30 June 2020 / Accepted: 24 August 2020 © The Author(s) 2020
Abstract The clinical features of xerostomia induced by immune checkpoint inhibitors (ICI) are similar to those of Sjögren’s syndrome (SS), whereas the immunohistological and serological features are known to differ from those of SS. However, the radiologic imaging features of salivary glands are not yet well known. We report a case of a 56-year-old male patient diagnosed with ICI-induced xerostomia. The patient underwent various imaging examinations to investigate the condition of the salivary glands, which indicated the following: (1) less specific findings on contrast-enhanced computed tomography, (2) mixed with intermediate and low signal intensity on both T1-weighted and fat-suppressed T2-weighted magnetic resonance imaging and poor “salt and pepper” appearance on magnetic resonance sialography, and (3) multiple ovoid hypoechoic areas with hyperechoic bands without acute sialadenitis on ultrasound. These radiologic imaging findings suggested remarkable lymphocyte infiltration, which could be a characteristic of ICI-induced xerostomia. Keywords Diagnostic imaging · Salivary gland · Xerostomia · Adverse drug event · Sjögren’s syndrome
Introduction To date, immune checkpoint inhibitors (ICI), including ipilimumab or nivolumab, are used for the treatment of various types of cancers. The mechanism of ICI against cancer * Kouji Katsura [email protected]‑u.ac.jp 1
Department of Oral Radiology, Niigata University Medical and Dental Hospital, 1‑754 Asahimachi‑dori, Chuo‑ku, Niigata City, Niigata 951‑8520, Japan
2
Oral Rehabilitation, Niigata University Medical and Dental Hospital, 1‑754 Asahimachi‑dori, Chuo‑ku, Niigata City, Niigata 951‑8520, Japan
3
Department of Preventive Dentistry, Niigata University Medical and Dental Hospital, 21‑754 Asahimachi‑dori, Chuo‑ku, Niigata City, Niigata 951‑8520, Japan
4
Division of Preventive Dentistry, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, 2‑5274 Gakkocho‑dori, Chuo‑ku, Niigata City, Niigata 951‑8514, Japan
5
Division of Oral and Maxillofacial Radiology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, 2‑5274 Gakkocho‑dori, Chuo‑ku, Niigata City, Niigata 951‑8514, Japan
cells is augmentation of the anticancer immune response by blocking the negative costimulation of T cells [1]. By contrast, ICI can induce many kinds of hyperimmune reactions, categorized as immune-related adverse events in normal organs. To date, lichenoid reactions, xerostomia, and dysgeusia have been the primary reported oral adverse events [2–8]. The mechanism of ICI-induced xerostomia is considered as an impairment of the PD-1/PD-L1 pathway
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