病例报告：免疫检查点抑制剂诱导的IgG4相关疾病模拟肾转移进展：利妥昔单抗成功的类固醇保留治疗
Case Report: Immune checkpoint inhibitor-induced IgG4-related disease mimicking renal metastatic progression: successful steroid-sparing management with rituximab.
摘要(中文译文)
免疫检查点抑制剂（ICIs）可诱发广谱的免疫相关不良事件（irAEs），包括罕见的纤维炎性自身免疫表现。IgG4相关性疾病（IgG4-RD）在接受双免疫检查点抑制剂治疗后仅有极少数报道。我们报告一例65岁男性转移性透明细胞肾细胞癌患者，在肾切除术后接受纳武利尤单抗联合伊匹木单抗治疗。尽管初始影像学表现稳定，随访计算机断层扫描显示孤立残留肾脏中新出现肿块样病变，提示转移性进展可能。CT引导下活检显示亚急性肾盂肾炎、急性肾小管损伤、席纹状纤维化及密集的IgG4阳性浆细胞浸润，符合IgG4-RD。由于认为糖皮质激素可能对抗肿瘤免疫监视产生不利影响，选择利妥昔单抗作为保留类固醇的一线治疗。两次利妥昔单抗输注（每次1000 mg）使肾脏病变达到影像学稳定/消退，同时肺部转移灶仍处于肿瘤学控制之下。本病例突出表明，IgG4-RD是双ICI治疗的一种罕见但临床上重要且易被忽视的irAE，可模仿恶性肿瘤进展。组织学确认至关重要，当优先考虑保留抗肿瘤免疫力时，采用利妥昔单抗进行B细胞清除可能是一种有效的治疗策略。
Abstract
Immune checkpoint inhibitors (ICIs) can induce a broad spectrum of immune-related adverse events (irAEs), including rare fibroinflammatory autoimmune manifestations. IgG4-related disease (IgG4-RD) has only exceptionally been described following dual ICI therapy. We report a 65-year-old man with metastatic clear cell renal carcinoma treated with nivolumab plus ipilimumab after nephrectomy. Despite initial radiologic stability, follow-up computed tomography revealed newly developed mass-like lesions in the solitary remaining kidney, raising suspicion of metastatic progression. CT-guided biopsy demonstrated subacute pyelonephritis, acute tubular injury, storiform fibrosis, and dense IgG4-positive plasma cell infiltration consistent with IgG4-RD. Because glucocorticoids were considered potentially detrimental to antitumor immune surveillance, rituximab was selected as steroid-sparing first-line therapy. Two infusions of rituximab (1000 mg each) led to radiologic stabilization/regression of renal lesions while pulmonary metastases remained under oncologic control. This case highlights IgG4-RD as a rare but clinically important underrecognized irAE of dual ICI therapy that may mimic malignant progression. Histologic confirmation is crucial, and B-cell depletion with rituximab may represent an effective treatment strategy when preservation of antitumor immunity is a priority.
如何引用
AMA
Mayara Elisa Bonatto, Jan Dvořák, Marek Kollár, David Girsa, Miroslav Průcha, Šárka Forejtová, et al. Case Report: Immune checkpoint inhibitor-induced IgG4-related disease mimicking renal metastatic progression: successful steroid-sparing management with rituximab.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1884821.
APA
Mayara Elisa Bonatto, Jan Dvořák, Marek Kollár, David Girsa, Miroslav Průcha, Šárka Forejtová, et al (2026). Case Report: Immune checkpoint inhibitor-induced IgG4-related disease mimicking renal metastatic progression: successful steroid-sparing management with rituximab.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1884821
GB/T 7714
Mayara Elisa Bonatto, Jan Dvořák, Marek Kollár, David Girsa, Miroslav Průcha, Šárka Forejtová, et al. Case Report: Immune checkpoint inhibitor-induced IgG4-related disease mimicking renal metastatic progression: successful steroid-sparing management with rituximab.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1884821.
在 PubMed增强版 阅读全文
翻译全文 · AI 文献问答 · PDF 原文下载 · 引用导出