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Mullally WJ, Cooke FJ, Crosbie IM, Kumar S, Abernethy VE, Jordan EJ, O'Connor M, Horgan AM, Landers R, Naidoo J, Calvert PM. Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma. Front Immunol 2022; 13:871217. [PMID: 35514990 PMCID: PMC9067158 DOI: 10.3389/fimmu.2022.871217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal pain, constipation, and fatigue. A computerized tomography scan did not identify a cause for his symptoms. This was rapidly followed by thrombocytopenia on day 11 and then anemia. He commenced intravenous corticosteroids for a suspected diagnosis of immune-related thrombocytopenia. On day 15, a generalized onset motor seizure occurred, and despite plasmapheresis later that day, the patient died from fatal immune-related thrombotic thrombocytopenic purpura (TTP). This was confirmed with suppressed ADAMTS13 (<5%) testing on day 14. Immune-related TTP is a rare and, in this case, fatal immune- related adverse event. Further studies are required to identify additional immunosuppressive management for immune-related TTP.
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Affiliation(s)
- W J Mullally
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - F J Cooke
- Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland
| | - I M Crosbie
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - S Kumar
- Department of Hematology, University Hospital Waterford, Waterford, Ireland
| | - V E Abernethy
- Department of Nephrology, University Hospital Waterford, Waterford, Ireland
| | - E J Jordan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - M O'Connor
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - A M Horgan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - R Landers
- Department of Pathology, University Hospital Waterford, Waterford, Ireland
| | - J Naidoo
- Royal College of Surgeons in Ireland (RCSI), Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.,RCSI University of Health Sciences, Dublin, Ireland.,Department of Medical Oncology , Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, MD, United States
| | - P M Calvert
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
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McLaren ZL, Abernethy VE, Dawson JK. Comment on: British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years). Rheumatology (Oxford) 2009; 48:1178-9; author reply 1179. [DOI: 10.1093/rheumatology/kep188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Estrach C, Mpofu S, Thompson RN, Williams E, Abernethy VE, Moots RJ. Swollen joint count as a predictor of response to anti-tumor necrosis factor ? therapy in rheumatoid arthritis: Comment on the article by Sokka and Pincus. ACTA ACUST UNITED AC 2003; 48:3611-3; author reply 3613-5. [PMID: 14674016 DOI: 10.1002/art.11335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaushik VV, Abernethy VE, Lynch MP, Dawson JK. Outcome measures for rheumatologists. Rheumatology (Oxford) 2003; 42:902-3; author reply 903. [PMID: 12826708 DOI: 10.1093/rheumatology/keg185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
We report a case of septic arthritis of an interphalangeal joint and osteomyelitis of the phalanx due toMycobacterium malmoense in a 61-year-old man with a 20 year history of rheumatoid arthritis treated with steroids and azathioprine. This was successfully treated with ethambutol, rifampicin and clarithromycin. To our knowledge this is the only reported case of septic arthritis due to this pathogen which is usually associated with respiratory disease or cervical lymphadenitis.
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Affiliation(s)
- S E Whitehead
- Department of Microbiology, Whiston Hospital, Prescot, Merseyside L35 5DR, UK
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Iglesias J, Abernethy VE, Wang Z, Lieberthal W, Koh JS, Levine JS. Albumin is a major serum survival factor for renal tubular cells and macrophages through scavenging of ROS. Am J Physiol 1999; 277:F711-22. [PMID: 10564234 DOI: 10.1152/ajprenal.1999.277.5.f711] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have previously shown that lysophosphatidic acid (LPA), an abundant serum lipid that binds with high affinity to albumin, is a potent survival factor for mouse proximal tubular cells and peritoneal macrophages. We show here that BSA also has potent survival activity independent of bound lipids. Delipidated BSA (dBSA) protected cells from apoptosis induced by FCS withdrawal at concentrations as low as 1% of that in FCS. dBSA did not activate phosphatidylinositol 3-kinase, implying that its survival activity occurs via a mechanism distinct from that for most cytokines. On the basis of the following evidence, we propose that dBSA inhibits apoptosis by scavenging reactive oxygen species (ROS): 1) FCS withdrawal leads to ROS accumulation that is inhibitable by dBSA; 2) during protection from apoptosis, sulfhydryl and hydroxyl groups of dBSA are oxidized; and 3) chemical blockage of free sulfhydryl groups or preoxidation of dBSA with H(2)O(2) removes its survival activity. Moreover, dBSA confers almost complete protection from cell death in a well-established model of oxidative injury (xanthine/xanthine oxidase). These results implicate albumin as a major serum survival factor. Inhibition of apoptosis by albumin occurs through at least two distinct mechanisms: carriage of LPA and scavenging of ROS.
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Affiliation(s)
- J Iglesias
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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Dawson JK, Campbell EA, Abernethy VE, Lynch MP. Health economics as an aspect of health outcome: basic principles and application in rheumatoid arthritis. Br J Rheumatol 1996; 35:494. [PMID: 8646445 DOI: 10.1093/rheumatology/35.5.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Harrison DJ, Simpson R, Kharbanda R, Abernethy VE, Nimmo G. Antibodies to neutrophil cytoplasmic antigens in Wegener's granulomatosis and other conditions. Thorax 1989; 44:373-7. [PMID: 2669221 PMCID: PMC461833 DOI: 10.1136/thx.44.5.373] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The use of serum antibodies to neutrophil cytoplasmic antigens (ANCA) as a diagnostic marker for Wegener's granulomatosis and other forms of vasculitis has been assessed. Although ANCA have been described by several groups the precise antigenic targets are unknown, and detection of ANCA still relies on an indirect immunofluorescence assay technique. Several different patterns of fluorescence have been produced by using sera from different groups of patients, and insufficient information is available on the frequency of positive results and of the patterns of immunofluorescence obtained when serum from patients with vasculitis as a part of a generalised connective tissue disease is used. A study was carried out on serum from 240 patients, including 23 patients with Wegener's granulomatosis, 12 with microscopic polyarteritis, and 30 with various connective tissue diseases. Three patterns of fluorescence were observed: bright coarsely granular cytoplasmic, bright non-granular cytoplasmic, and weak diffuse cytoplasmic. The bright, coarsely granular pattern was 86% specific for Wegener's granulomatosis in this series and was observed in 18 of 23 cases. Other patterns of fluorescence were found in various conditions and were not of diagnostic value. The technique is simple, inexpensive, rapid, and reproducible.
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Affiliation(s)
- D J Harrison
- University Department of Pathology, Royal Infirmary, Edinburgh
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