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Rapid onset pembrolizumab-induced inflammatory arthritis diagnosed using musculoskeletal ultrasound
  1. Kate Harnden1,
  2. Andrea Di Matteo1,2,
  3. Keith Howell2 and
  4. Kulveer Mankia1,2
  1. 1University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, West Yorkshire, UK
  2. 2Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Kate Harnden; kate.harnden{at}nhs.net

Abstract

Immune checkpoint inhibitors have revolutionised the treatment of cancer. While very effective, they commonly cause a wide spectrum of immune-related adverse events. These immune-related adverse events can be fatal and often have significant effects on quality of life. They therefore require prompt recognition and management. We report the case of a woman presenting with widespread joint pain and stiffness 6 hours after her first pembrolizumab infusion. She had no joint swelling on physical examination but an ultrasound scan revealed widespread musculoskeletal inflammation, confirming the diagnosis of inflammatory arthritis. To the best of our knowledge, this is the fastest reported inflammatory arthritis onset following immune checkpoint inhibitor treatment. It highlights the importance of timely imaging in patients on immune checkpoint inhibitors who present with new non-specific musculoskeletal pain. Her symptoms improved dramatically with intramuscular triamcinolone injection.

  • Ultrasonography
  • Musculoskeletal syndromes
  • Unwanted effects / adverse reactions
  • Skin cancer

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and critical revision for important intellectual content: KHa, ADM, KHo and KM. The following authors gave final approval of the manuscript: KHa, ADM, KHo and KM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests There is no specific grant for this research from any funding agency. KHa, ADM and KHo have no conflicts of interest to declare. KM has grants from Lilly, Gilead and Serac Life Sciences. KM has consulting fees from Serac Life Sciences and Lilly. KM has payment for lectures from AbbVie, Galapagos and UCB. KM has support for attending meetings from AbbVie.

  • Provenance and peer review Not commissioned; externally peer reviewed.