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Rheumatology Case Report: Immune-Related Aortitis Associated with Ipilimumab

Byung H. Ban, DO, Jayne L. Crowe, MD, & Robert M. Graham, MD  |  Issue: May 2017  |  May 17, 2017

Physicians must be aware of the possibility of a patient’s developing aortitis as an irAE secondary to ipilimumab therapy. Early diagnosis and prompt management with systemic corticosteroid therapy are critical to avoiding a potentially fatal outcome.


Byung Hoon Ban, DOByung Hoon Ban, DO, is a first-year internal medicine physician in the Department of Internal Medicine at the University of Tennessee at Chattanooga. He aspires to become a clinical rheumatologist after he completes his residency.

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Jayne Littlejohn Crowe, MDJayne Littlejohn Crowe, MD, completed her rheumatology training at Emory University Hospital in Atlanta, and now works at Erlanger Health Systems and serves as an assistant professor in the Department of Rheumatology at the University of Tennessee at Chattanooga.

Robert Matthew Graham, MDRobert Matthew Graham, MD, completed his hematology-oncology fellowship at Wake Forest University, Wake Forest Baptist Medical Center in Winston-Salem, N.C. He now serves as the division chief of hematology-oncology and as an assistant professor of medicine at the University of Tennessee at Chattanooga.

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References

  1. Fellner C. Ipilimumab (Yervoy) prolongs survival in advanced melanoma: Serious side effects and a hefty price tag may limit its use. P T. 2012 Sep;37(9):503–530.
  2. Weber J. Review: Anti-CTLA-4 antibody ipilimumab: Case studies of clinical response and immune-related adverse events. Oncologist. 2007 Jul;12(7):864–872.
  3. Suarez-Almazor ME, Kim ST, Abdel-Wahab N, Diab A. Immune-related adverse events with the use of checkpoint inhibitors for immunotherapy of cancer. Arthritis Rheumatol. 2017 Apr;69(4):687–699.
  4. Goldstein BL, Gedmintas L, Todd DJ. Drug-associated polymyalgia rheumatica/giant cell arteritis occurring in two patients after treatment with ipilimumab, an antagonist of CTLA-4. Arthritis Rheumatol. 2014 Mar;66(3):768–769.
  5. Minor DR, Bunker SR, Doyle J. Lymphocytic vasculitis of the uterus in a patient with melanoma receiving ipilimumab. J Clin Oncol. 2013 Jul 10;31(20):e356.
  6. Johnson DB, Balko JM, Compton ML, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med. 2016 Nov 3;375(18):1749–1755.
  7. Yun S, Vincelette ND, Mansour I, et al. Late onset ipilimumab-induced pericarditis and pericardial effusion: A rare but life threatening complication. Case Rep Oncol Med. 2015;2015:794842.
  8. Heinzerling L, Ott PA, Hodi FS, et al. Cardiotoxicity associated with CTLA4 and PD1 blocking immunotherapy. J Immunother Cancer. 2016 Aug 16;4:50.
  9. Ludlow SP, Kay N. Delayed dermatologic hypersensitivity reaction secondary to ipilimumab. J Immunother. 2015 May;38(4):165–166.
  10. Horvat TZ, Adel NG, Dang TO, et al. Immune-related adverse events, need for systemic immunosuppression, and effects on survival and time to treatment failure in patients with melanoma treated with ipilimumab at Memorial Sloan Kettering Cancer Center. J Clin Oncol. 2015 Oct 1;33(28):3193–3198.
  11. Heinzerling L, Goldinger SM. A review of serious adverse effects under treatment with checkpoint inhibitors. Curr Opin Oncol. 2017 Mar;29(2):136–144.
  12. Ipilimumab package insert.
  13. Friedman CF, Proverbs-Singh TA, Postow MA. Treatment of the immune-related adverse effects of immune checkpoint inhibitors: A review. JAMA Oncol. 2016 Oct 1;2(10):1346–1353.
  14. Kumar V, Chaudhary N, Garg M, et al. Current diagnosis and management of immune related adverse events (irAEs) induced by immune checkpoint inhibitor therapy. Front Pharmacol. 2017 Feb 8;8:49.

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Filed under:Conditions Tagged with:adverse eventsaortitiscase reportClinicalCorticosteroidsdrugImmunologyipilimumabManagementoutcomepatient carerheumatologistrheumatologytherapyTreatment

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