A case of pembrolizumab-induced hemophagocytic lymphohistiocytosis successfully treated with pulse glucocorticoid therapy

• Published in: Respiratory medicine case reports Vol. 30; p. 101097
• Main Authors: Takahashi, Hidenori, Koiwa, Tomohiro, Fujita, Akira, Suzuki, Takayuki, Tagashira, Amane, Iwasaki, Yoshinobu
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.01.2020; Elsevier
• Subjects: Case Report
• ISSN: 2213-0071; 2213-0071
• DOI: 10.1016/j.rmcr.2020.101097

Treatments using immune checkpoint inhibitors such as pembrolizumab lead to immune mediated adverse effects including hemophagocytic lymphohistiocytosis (HLH). Herein, we present a case where HLH developed after pembrolizumab administration, which was treated using high dose prednisolone. He developed high-grade fever complicated with liver dysfunction and diarrhea 7 days after pembrolizumab administration. Although treatment with oral prednisolone alleviated the symptoms, other adverse effects arose owing to a tapered prednisolone dose. Hyperferritinemia suggested the diagnosis of HLH and met the criteria for HLH diagnosis. He was thus administered intravenous pulses of methylprednisolone followed by high-dose oral prednisolone, which resolved these symptoms. •First case of fully-described hemophagocytic lymphohistiocytosis (HLH) induced by pembrolizumab including pathological findings.•In this case, the precede dosage of mid-dose glucocorticoids failed to control HLH.•The patient was treated with high-dose glucocorticoids successfully.