OncoTargets and Therapy (Nov 2019)
Pancytopenia And Limbic Encephalopathy Complicating Immunotherapy For Clear Cell Endometrial Cancer With Microsatellite Instability-High (MSI-H)
Abstract
Aladdin Kanbour,1 Kakil Ibrahim Rasul,1 Salha Bujassoum Albader,1 Reem Jawad Al Sulaiman,1 Gayan Melikyan,2 Hanan Farghaly,3 Zsolt Lengyel,4 Yousef Al Rimawi,5 Dina Soliman,6 Nabil Elhadi Omar7 1Department of Medical Oncology, Hamad Medical Corporation, National Center Cancer Care and Research, Doha, Qatar; 2Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; 3Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar; 4Department of Body Imaging, Hamad Medical Corporation, Doha, Qatar; 5Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar; 6Department of Hematology, Hamad Medical Corporation, National Center for Cancer Care and Research, Doha, Qatar; 7Pharmacy Department, Hamad Medical Corporation, National Center for Cancer Care and Research, Doha, QatarCorrespondence: Nabil Elhadi OmarPharmacy Department, Hamad Medical Corporation, National Center for Cancer Care and Research, Doha 3050, QatarEmail [email protected]: Clear cell carcinoma of the endometrium (CCE) has a tendency to occur in a mismatch repair protein deficient molecular background. Treatment with immunotherapy can predict a favorable response.Case presentation: We are presenting a 53-year-old female, diagnosed with CCE 17 years ago, who was treated initially with hysterectomy and left salpingo-oophorectomy, who relapsed a few months later, and was then treated with left pelvic mass excision and sigmoidectomy. Recently, the disease recurred as a retroperitoneal lymphadenopathy, which was resected but then relapsed locally, spread to the lungs, and progressed further after three lines of chemotherapy. On pathological review of the tumor, it was found to harbor loss of nuclear expression of MLH-1 and PMS-2. Based on a strong predictor of response to immunotherapy, pembrolizumab was tried. However, within a few days of the single dose of pembrolizumab, immune thrombocytopenia followed by pancytopenia, recurrent seizures, visual hallucination, and cerebellar signs consistent with limbic encephalitis developed, which were not responding to steroid and intravenous immunoglobulin.Conclusion: We are presenting a case of a CCE with deficient mismatch repair that developed two autoimmune side effects, pancytopenia and limbic encephalitis, within a few days of a single injection of pembrolizumab.Keywords: pancytopenia, limbic encephalitis, clear cell endometrial cancer, clear cell carcinoma of the endometrium, microsatellite instability-high, MSI-H, pembrolizumab
