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日本呼吸器学会英文誌 Respiratory Investigation
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Abstract

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Article in Japanese

Case Report

A case of MPO-ANCA-positive alveolar hemorrhage induced by pembrolizumab

Makiko Kitajimaa  Sachiko Shioyab  Takatsune Hosoyaa  Takuma Kitajimaa  Kouhei Kawasakia  Tomoko Suzukia 

aDepartment of Pulmonary Medicine, JA Onomichi General Hospital
bDepartment of Pulmonary Medicine, Innoshima Medical Association Hospital

ABSTRACT

An 84-year-old man with advanced bladder cancer had received pembrolizumab as second-line chemotherapy. One week after the initiation of pembrolizumab therapy, he had symptoms of fever and blood sputum. Computed tomography scan showed bilateral ground glass opacities and consolidations. Bronchoscopy showed active bleeding from the right middle lobe, and bronchoalveolar lavage fluid revealed alveolar hemorrhage pattern. The serum level of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) was high (41.3 EU). Based on these findings, a diagnosis of MPO-ANCA-positive alveolar hemorrhage induced by pembrolizumab was made. The clinical findings were improved rapidly by corticosteroid therapy and withdrawal of pembrolizumab. This is an important case of alveolar hemorrhage associated with MPO-ANCA as an immune-related adverse event of immune checkpoint inhibitor therapy.

KEYWORDS

Myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)  Immune checkpoint inhibitor (ICI)  Immune-related adverse event (irAE)  Alveolar hemorrhage 

Received 11 Oct 2020 / Accepted 25 Jan 2021

AJRS, 10(3): 283-287, 2021

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