Case Report: Immune checkpoint inhibitor–induced multiorgan vasculitis successfully treated with rituximab

• Published in: Frontiers in Nephrology (Online) 2023-07, Vol.3
• Main Authors: Qureshi, Sehrish, Arani, Naszrin, Parvathareddy, Vishnu, Tchakarov, Amanda, Abdelrahim, Maen, Suarez-Almazor, Maria, Zhang, Jianjun, Gibbons, Don Lynn, Heymach, John, Altan, Mehmet, Abudayyeh, Ala
• Format: Article
• Language: English
• Subjects: acute renal failure; autoimmune induction; immune check inhibitor; Nephrology; rituximab; vasculitis
• ISSN: 2813-0626; 2813-0626
• DOI: 10.3389/fneph.2023.1168614

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of cancer. ICIs have a unique side effect profile, generally caused by inflammatory tissue damage, with clinical features similar to autoimmune conditions. Acute kidney injury from ICIs has been well studied; incidence ranges from 1% to 5%, with higher incidence when combination ICI therapies are used. Although the overall reported incidence of ICI-associated glomerulonephritis is less than 1%, vasculitis is the most commonly reported ICI-related glomerulonephritis. Other biopsy findings include thrombotic microangiopathy, focal segmental glomerulosclerosis, minimal change disease, and IgA nephropathy with secondary amyloidosis. We report a case in which a woman previously treated with the PD-L1 inhibitor durvalumab for locally advanced non-small cell lung cancer with pre-existing antineutrophil cytoplasmic (anti-PR3) antibody who later developed multi-organ vasculitis after ICI exposure, which was successfully treated with rituximab, with continued cancer remission for 3 years.