Chest
Volume 143, Issue 3, March 2013, Pages 858-861
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Selected Reports
Organizing Pneumonia as a Side Effect of Ipilimumab Treatment of Melanoma

https://doi.org/10.1378/chest.12-1467Get rights and content

Ipilimumab is one of the newly developed human monoclonal antibodies used in the treatment of metastatic melanoma. Its primary mechanism of action is a specific blockade of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), a T-cell receptor responsible for inhibition of lymphocyte activation. By blocking CTLA-4, ipilimumab enhances immune responses against tumor cells, but also exposes normal tissues to an increased risk of autoimmune phenomena as a potential side effect. In this report, we describe the case of a 58-year-old woman with metastatic melanoma who was treated with ipilimumab in the weeks prior to the onset of severe nonresolving dyspnea and cough. Extensive workup revealed organizing pneumonia as the cause of her hypoxemic respiratory failure and treatment with steroids led to a resolution of her pulmonary disease. To our knowledge, this is the first report of pulmonary toxicity caused by ipilimumab, which manifested on pathology as organizing pneumonia.

Section snippets

Case Report

A 58-year-old white woman was admitted to our hospital with complaints of cough and dyspnea starting 2 weeks previously. Despite a 7-day course of azithromycin, her cough persisted and she developed worsening shortness of breath. Past medical history was significant for recently diagnosed melanoma of the foot with metastasis to the inguinal lymph nodes, cryptogenic cirrhosis, hypertension, hyperlipidemia with a history of stroke, and a positive anticardiolipin antibody. Home medications

Discussion

The CTLA-4 receptor on T lymphocytes is a negative regulator of lymphocyte activation that binds to B7 on antigen-presenting cells, resulting in an inhibitory signal to the T cell.1 Ipilimumab has a high affinity for CTLA-4, effectively impeding binding to B7, which may potentiate T-cell activation against tumor cells. Ipilimumab has been shown to have a survival benefit in treating metastatic melanoma2 and is also being investigated as potential treatment of hematologic malignancies,3, 4 and

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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