Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2023; 11(14): 3267-3274
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3267
Immune checkpoint inhibitor therapy-induced autoimmune polyendocrine syndrome type II and Crohn’s disease: A case report
Mei-Juan Gao, Yan Xu, Wen-Bo Wang
Mei-Juan Gao, Yan Xu, Wen-Bo Wang, Department of Endocrinology, Peking University Shougang Hospital, Beijing 100041, China
Author contributions: Gao MJ and Xu Y provided clinical care for the patient; Gao MJ wrote the manuscript; Wang WB was the attending consultant, and he reviewed the final draft of the manuscript; All authors contributed to the writing, editing, and review of the manuscript.
Informed consent statement: The patient and his family signed a letter of consent to the summary of the case report and the publication of the informed notice.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei-Juan Gao, MD, Chief Physician, Department of Endocrinology, Peking University Shougang Hospital, No. 9 Jinyuanzhuang Road, Beijing 100041, China. gmjluhe@163.com
Received: December 4, 2022
Peer-review started: December 4, 2022
First decision: February 7, 2023
Revised: February 17, 2023
Accepted: April 6, 2023
Article in press: April 6, 2023
Published online: May 16, 2023
Processing time: 162 Days and 19.3 Hours
Abstract
BACKGROUND

The development of immune checkpoint inhibitors (ICIs) has heralded a new era in cancer treatment, enabling the possibility of long-term survival in patients with metastatic disease. Unfortunately, ICIs are increasingly implicated in the development of autoimmune diseases.

CASE SUMMARY

We present a man with squamous cell carcinoma of the oropharynx on a combination of teriprizumab, docetaxel, and cisplatin therapy who developed autoimmune polyendocrine syndrome type II (APS-2) including thyroiditis and type 1 diabetes mellitus and Crohn’s disease (CD). He developed thirst, abdominal pain, and fatigue after two-week treatment with the protein 1 ligand inhibitor teriprizumab. Biochemistry confirmed APS-2 and thyrotoxicosis. He was commenced on an insulin infusion. However, his abdominal pain persisted. Follow-up surgery confirmed CD and his abdominal pain was relieved by mesalazine. He was continued on insulin and mesalazine therapy.

CONCLUSION

Immunotherapy can affect all kinds of organs. When clinical symptoms cannot be explained by a single disease, clinicians should consider the possibility of multisystem damage.

Keywords: Immune checkpoint inhibitor; Programmed cell death protein 1 ligand; Autoimmune polyendocrine syndrome type II; Type 1 diabetes mellitus; Thyroiditis; Crohn’s disease; Case report

Core Tip: We report a rare case of multi-system damage induced by cancer therapy with protein 1 ligand inhibitor teriprizumab. A man with squamous cell carcinoma of oropharynx on a combination regimen of teriprizumab, docetaxel, and cisplatin developed autoimmune polyendocrine syndrome type II (APS-2) including thyroiditis and type 1 diabetes mellitus (T1DM) and Crohn’s disease (CD). This case report highlights the possibility of chronic immune toxicities and the long-term implications of cancer immunotherapy. To the best of our knowledge, this is the first reported case of concurrent atypical APS-2 (including T1DM and thyrotoxicosis) and CD in a patient receiving immunotherapy for metastatic nasopharyngeal carcinoma.