Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review
IntroductionImmune Checkpoint Inhibitors (ICIs) may cause various immune- related Adverse Events (irAEs). Of these events, vascular involvement is still considered an uncommon irAEs and generally concerns large or medium vessels. Acral small-vessel vasculitis can lead to severe digital necrosis.Case...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1537825/full |
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| author | Valérian Rivet Benoit Guillon Vincent Sibaud Jérémie Dion Andréa Pastissier Karen Delavigne Pierre Cougoul Odile Rauzy Thibault Comont |
| author_facet | Valérian Rivet Benoit Guillon Vincent Sibaud Jérémie Dion Andréa Pastissier Karen Delavigne Pierre Cougoul Odile Rauzy Thibault Comont |
| author_sort | Valérian Rivet |
| collection | DOAJ |
| description | IntroductionImmune Checkpoint Inhibitors (ICIs) may cause various immune- related Adverse Events (irAEs). Of these events, vascular involvement is still considered an uncommon irAEs and generally concerns large or medium vessels. Acral small-vessel vasculitis can lead to severe digital necrosis.Case presentationHerein, we present three cases after treatment with pembrolizumab, nivolumab, and combination nivolumab/ipilimumab for lung adenocarcinoma, renal cell carcinoma, and melanoma, respectively. Two patients had a Raynaud’s-like syndrome. All of them presented with digital ischemia of both hands and with severe acral necrosis in the first case. Management consisted in ICI discontinuation, high-dose steroids, and vasodilator agents with good evolution in the three cases. No rechallenge of ICI has been attempted.DiscussionWe found 12 other cases in the literature review to build a cohort of 15 patients, mostly male with a median age of 60 years. Lung cancer and melanoma are the most common tumors. The most frequently used ICI was pembrolizumab. The median time to onset was 8 weeks. The main clinical presentation was a distal and painful necrosis mostly on thehands with bilateral involvement. Toes were affected in only two cases. All cases were severe features with grade ≥ 3. Eleven patients were treated with steroids and vasodilator agents. ICI was discontinued permanently in all patients.ConclusionICI-induced small-vessel vasculitis can lead to severe digital ischemia, often in males, and is preceded by a Raynaud’s-like syndrome with mostly bilateral and hand involvement. Data are still missing to optimize management of these kinds of patients. |
| format | Article |
| id | doaj-art-1adbf19d036a4e5c85e01ea759210515 |
| institution | DOAJ |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-1adbf19d036a4e5c85e01ea7592105152025-08-20T02:56:05ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-05-011510.3389/fonc.2025.15378251537825Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature reviewValérian Rivet0Benoit Guillon1Vincent Sibaud2Jérémie Dion3Andréa Pastissier4Karen Delavigne5Pierre Cougoul6Odile Rauzy7Thibault Comont8Internal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceDermatology Department – Medical Oncology, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceDermatology Department – Medical Oncology, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceInternal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceInternal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceInternal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceInternal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceInternal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceInternal Medicine and Immunopathology Department, The Cancer University of Toulouse Oncopole, University Hospital Center of Toulouse, Toulouse, FranceIntroductionImmune Checkpoint Inhibitors (ICIs) may cause various immune- related Adverse Events (irAEs). Of these events, vascular involvement is still considered an uncommon irAEs and generally concerns large or medium vessels. Acral small-vessel vasculitis can lead to severe digital necrosis.Case presentationHerein, we present three cases after treatment with pembrolizumab, nivolumab, and combination nivolumab/ipilimumab for lung adenocarcinoma, renal cell carcinoma, and melanoma, respectively. Two patients had a Raynaud’s-like syndrome. All of them presented with digital ischemia of both hands and with severe acral necrosis in the first case. Management consisted in ICI discontinuation, high-dose steroids, and vasodilator agents with good evolution in the three cases. No rechallenge of ICI has been attempted.DiscussionWe found 12 other cases in the literature review to build a cohort of 15 patients, mostly male with a median age of 60 years. Lung cancer and melanoma are the most common tumors. The most frequently used ICI was pembrolizumab. The median time to onset was 8 weeks. The main clinical presentation was a distal and painful necrosis mostly on thehands with bilateral involvement. Toes were affected in only two cases. All cases were severe features with grade ≥ 3. Eleven patients were treated with steroids and vasodilator agents. ICI was discontinued permanently in all patients.ConclusionICI-induced small-vessel vasculitis can lead to severe digital ischemia, often in males, and is preceded by a Raynaud’s-like syndrome with mostly bilateral and hand involvement. Data are still missing to optimize management of these kinds of patients.https://www.frontiersin.org/articles/10.3389/fonc.2025.1537825/fullacral vasculitisimmune checkpoint inhibitorsimmune-related adverse eventsnivolumabpembrolizumabipilimumab |
| spellingShingle | Valérian Rivet Benoit Guillon Vincent Sibaud Jérémie Dion Andréa Pastissier Karen Delavigne Pierre Cougoul Odile Rauzy Thibault Comont Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review Frontiers in Oncology acral vasculitis immune checkpoint inhibitors immune-related adverse events nivolumab pembrolizumab ipilimumab |
| title | Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review |
| title_full | Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review |
| title_fullStr | Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review |
| title_full_unstemmed | Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review |
| title_short | Case Report: Acral vasculitis induced by Immune Checkpoint Inhibitors: a case series and literature review |
| title_sort | case report acral vasculitis induced by immune checkpoint inhibitors a case series and literature review |
| topic | acral vasculitis immune checkpoint inhibitors immune-related adverse events nivolumab pembrolizumab ipilimumab |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1537825/full |
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