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Abstract

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Article in Japanese

Case Report

A case of nivolumab-induced thrombotic thrombocytopenic purpura successfully treated with systemic glucocorticoids

Masaru Ito*  Hiroaki Saito  Rina Kato  Tomohiro Moriya  Naoki Kawakami  Kazuhito Saito 

Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital
*Present address: Department of Respiratory Medicine, Tokyo Medical and Dental University, Medical Hospital

ABSTRACT

A 70-year-old man was diagnosed with lung adenocarcinoma [cT1cN1M1c (BRA), Stage IVB] and received nivolumab as the second-line treatment. After seven cycles of nivolumab, thrombocytopenia occurred. Since the platelet counts increased and decreased after discontinuation of nivolumab, a bone marrow biopsy was performed. We considered immune thrombocytopenia as a differential diagnosis because of the increase in megakaryocytes; however, we continued to observe the patient due to the normalization of the platelet count. A few days later, he was hospitalized for cerebellar hemorrhage, and laboratory results revealed significant thrombocytopenia and hemolytic anemia. We suspected an immune-related adverse event secondary to nivolumab, and administered systemic glucocorticoids, following which the platelet counts increased immediately. Laboratory results revealed severe deficiency of a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs, member 13 (ADAMTS13) activity, and the presence of ADAMTS13 inhibitor. The final diagnosis was acquired thrombotic thrombocytopenic purpura (TTP) secondary to nivolumab. Although rare, TTP should be considered as a differential diagnosis of thrombocytopenia after the administration of nivolumab.

KEYWORDS

Nivolumab  Thrombocytopenia  Thrombotic thrombocytopenic purpura (TTP)  Immune-related adverse event (irAE) 

Received 20 Jan 2021 / Accepted 19 Mar 2021

AJRS, 10(4): 373-377, 2021

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