Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report
We report a rare hematological immune-related adverse event (irAE) induced by durvalumab, an immune checkpoint inhibitor, after conversion surgery in a patient with intrahepatic cholangiocarcinoma (ICC). A 72-year-old male was admitted for recurrent ICC treatment in the posterior sector. The primary...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1610190/full |
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| author | Yoshihito Kitamura Seiichi Shimizu Shintaro Kuroda Naruhiko Honmyo Ryosuke Nakano Hiroshi Sakai Hiroyuki Tahara Masahiro Ohira Kentaro Ide Tsuyoshi Kobayashi Tatsuo Ichinohe Hideki Ohdan |
| author_facet | Yoshihito Kitamura Seiichi Shimizu Shintaro Kuroda Naruhiko Honmyo Ryosuke Nakano Hiroshi Sakai Hiroyuki Tahara Masahiro Ohira Kentaro Ide Tsuyoshi Kobayashi Tatsuo Ichinohe Hideki Ohdan |
| author_sort | Yoshihito Kitamura |
| collection | DOAJ |
| description | We report a rare hematological immune-related adverse event (irAE) induced by durvalumab, an immune checkpoint inhibitor, after conversion surgery in a patient with intrahepatic cholangiocarcinoma (ICC). A 72-year-old male was admitted for recurrent ICC treatment in the posterior sector. The primary treatment chosen was systemic chemotherapy with durvalumab combined with gemcitabine and cisplatin. After eight cycles of chemotherapy, partial hepatectomy was performed against three nodules of ICC at liver segments 6 and 7 as conversion surgery. Approximately 3 months after the last injection of durvalumab, the patient was readmitted to our department due to a high fever. The number of neutrophils dropped to zero. Despite daily administration of granulocyte colony-stimulating factor, the patient had agranulocytosis with neutrophil counts remaining between 0 and 80/µL for 16 days. The results of the bone marrow biopsy indicated that the patient had cytotoxicity due to autoimmunity against the common progenitor cells of granulocytes and monocytes as an adverse reaction to durvalumab. The patient was diagnosed with immune-related neutropenia and started on steroid bolus therapy. Four days after initiating steroid therapy, the neutrophil count began to improve, reaching 1540/µL after 7 days, and remained stable thereafter. This case highlights the potential for durvalumab-induced immune-related agranulocytosis following conversion surgery in a patient with ICC, emphasizing the importance of careful monitoring and timely management of irAEs, particularly in the context of postoperative infections. |
| format | Article |
| id | doaj-art-87625bfa4fde4a3db156b6a420a6af82 |
| institution | DOAJ |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-87625bfa4fde4a3db156b6a420a6af822025-08-20T03:17:51ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-07-011610.3389/fimmu.2025.16101901610190Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case reportYoshihito Kitamura0Seiichi Shimizu1Shintaro Kuroda2Naruhiko Honmyo3Ryosuke Nakano4Hiroshi Sakai5Hiroyuki Tahara6Masahiro Ohira7Kentaro Ide8Tsuyoshi Kobayashi9Tatsuo Ichinohe10Hideki Ohdan11Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanDepartment of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, JapanDepartment of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima, JapanWe report a rare hematological immune-related adverse event (irAE) induced by durvalumab, an immune checkpoint inhibitor, after conversion surgery in a patient with intrahepatic cholangiocarcinoma (ICC). A 72-year-old male was admitted for recurrent ICC treatment in the posterior sector. The primary treatment chosen was systemic chemotherapy with durvalumab combined with gemcitabine and cisplatin. After eight cycles of chemotherapy, partial hepatectomy was performed against three nodules of ICC at liver segments 6 and 7 as conversion surgery. Approximately 3 months after the last injection of durvalumab, the patient was readmitted to our department due to a high fever. The number of neutrophils dropped to zero. Despite daily administration of granulocyte colony-stimulating factor, the patient had agranulocytosis with neutrophil counts remaining between 0 and 80/µL for 16 days. The results of the bone marrow biopsy indicated that the patient had cytotoxicity due to autoimmunity against the common progenitor cells of granulocytes and monocytes as an adverse reaction to durvalumab. The patient was diagnosed with immune-related neutropenia and started on steroid bolus therapy. Four days after initiating steroid therapy, the neutrophil count began to improve, reaching 1540/µL after 7 days, and remained stable thereafter. This case highlights the potential for durvalumab-induced immune-related agranulocytosis following conversion surgery in a patient with ICC, emphasizing the importance of careful monitoring and timely management of irAEs, particularly in the context of postoperative infections.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1610190/fullagranulocytosisdurvalumabimmune-related adverse eventintrahepatic cholangiocarcinomaconversion surgery |
| spellingShingle | Yoshihito Kitamura Seiichi Shimizu Shintaro Kuroda Naruhiko Honmyo Ryosuke Nakano Hiroshi Sakai Hiroyuki Tahara Masahiro Ohira Kentaro Ide Tsuyoshi Kobayashi Tatsuo Ichinohe Hideki Ohdan Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report Frontiers in Immunology agranulocytosis durvalumab immune-related adverse event intrahepatic cholangiocarcinoma conversion surgery |
| title | Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report |
| title_full | Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report |
| title_fullStr | Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report |
| title_full_unstemmed | Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report |
| title_short | Durvalumab induced immune-related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma: a case report |
| title_sort | durvalumab induced immune related agranulocytosis after conversion surgery in a patient with intrahepatic cholangiocarcinoma a case report |
| topic | agranulocytosis durvalumab immune-related adverse event intrahepatic cholangiocarcinoma conversion surgery |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1610190/full |
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