Polyarthritis, Tenosynovitis and Dry Eyes after Treatment by Immune Check-Point Inhibitors

摘要

Introduction: Immune checkpoint inhibitors targeting programmed deathprotein-1 and cytotoxic-T-lymphocyte-antigen-4 have revolutionized the treatmentof various cancers. Despite their effectiveness, these therapies can leadto immune related adverse events. Observation: We reported a case of a 43-year-old white woman who was referred to our department for a managementof acute polyarthritis. She was followed for a relapsing metastatic melanoma(stage IIIb) by surgery and Pembrolizumab, an immune checkpointinhibitor targeting programmed death protein-1. After receiving her 4~(th) cycleof this therapy she developed arthritis of the knees and the ankles, tenosynovitisand dry eyes with keratitis. After exclusion of other causes of polyarthritissuch as connective-tissue disease, the diagnosis of rheumatologic immunerelatedadverse events was retained. She was treated by 20 mg of prednisonedaily, Pembrolizumab was discontinued. The evolution was favorable. Conclusion: Rheumatologic manifestations secondary to immune checkpoint inhibitorshave been less well described in the literature. Their managementrequires the collaboration of oncologists and rheumatologists to limit the diagnosticdelay and for an appropriate therapeutic choice according to theirseverity.