[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-373021-105":59,"doc-detail-373021-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","management-of-multiorgan-failure-caused-by-immune-checkpoint-inhibitor-toxicity","Management of multiorgan failure caused by immune checkpoint inhibitor toxicity","","Immune checkpoint inhibitors (ICIs) improve treatment outcomes for aggressive cancers, yet they can trigger severe immunerelated adverse events (irAEs). A woman in her early 70s with metastatic lung adenocarcinoma began pembrolizumab and rapidly developed acute stroke, followed by irAE-related multiorgan failure requiring intensive care. Despite aggressive therapy, she remained critically ill and died the same day after transitioning to end-of-life care. The case underscores the life-threatening risk of irAEs and the need for early diagnosis and vigilant management to optimize timely intervention and outcomes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/management-of-multiorgan-failure-caused-by-immune-checkpoint-inhibitor-toxicity/373021/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/management-of-multiorgan-failure-caused-by-immune-checkpoint-inhibitor-toxicity/373021.png","ImageObject",300,407,{"name":92,"@type":93},"Aria","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-28","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What problem does this case report focus on?","Question",{"text":113,"@type":114},"It focuses on multiorgan failure caused by immune checkpoint inhibitor toxicity (irAEs) in a patient treated with pembrolizumab.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the patient present after starting pembrolizumab?",{"text":118,"@type":114},"After initiating pembrolizumab, she developed altered mental status with concern for stroke, including severe hypotension and abnormal neurologic findings.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is early suspicion of irAEs emphasized for ICI-treated patients?",{"text":122,"@type":114},"Because irAEs can be life-threatening, and early diagnosis and timely intervention are crucial to improve outcomes despite aggressive management challenges.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},373021,1790322802,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":105},2336464648322,"https://ap-avatar.wpscdn.com/avatar/2200025388227c56fec?_k=1778556882303663488","Case report  \nManagement of multiorgan failure caused by immune checkpoint inhibitor toxicity  \nTushita Verma  1 Altamash Jawadi  1 Shozab Ahmed2  \n, ,  \n1Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA  \n2Pulmonary and Critical Care, University of New Mexico, Albuquerque, New Mexico, USA  \nCorrespondence to  \nDr Tushita Verma;  \n[tverma@salud.unm.edu](tverma@salud.unm.edu)  \nAccepted 18 January 2025  \n© BMJ Publishing Group Limited 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.  \nTo cite: Verma T, Jawadi A, Ahmed S. BMJ Case Rep 2025;18:e262209 . doi:10 . 1136/bcr-2024- 262209  \nSUMMARY  \nImmune checkpoint inhibitors (ICIs) block inhibitory pathways that tumour cells exploit to evade the immune system. They play a key role in the management of aggressive cancers, including non-small cell lung cancer, melanoma and Hodgkin’s lymphoma. Despite their efficacy, ICIs can cause severe, potentially fatal, immunerelated adverse events (irAEs), including multiorgan failure. We present a case of a woman in her early 70s with metastatic lung adenocarcinoma recently initiated on pembrolizumab who presented with an acute stroke complicated by irAE-related multiorgan failure. Despite aggressive treatment, the patient remained critically ill and passed away the same day after transitioning to end-of-life care. This case emphasises the life-threatening potential of irAEs, the importance of early diagnosis and the challenges of managing these complications. Clinicians should maintain a high index of suspicion for irAEs in ICI-treated patients to optimise timely intervention and outcomes.  \nBACKGROUND  \nThe management of malignancy is multimodal, often comprising some combination of surgery, chemotherapy and radiation therapy. However, in the last few decades, immunotherapy has advanced the treatment of many malignancies, including many aggressive cancers such as non-small cell lung cancer, melanoma and Hodgkin’s lymphoma.1 These treatments target key receptors in the immune system, including cytotoxic T-lymphocyteassociated protein 4 (CTLA-4) and programmed cell death protein-1 (PD-1), which function as immune checkpoints and are negative regulators of T-cell immune function.2 CTLA-4 can potently upregulate lymphocyte function-associated antigen 1 (LFA-1) adhesion using receptor clustering.3 Active LFA-1 is needed for antigen presentation by antigen-presenting cells and migration of T-cells to intravascular regions, peripheral lymph nodes and inflammatory sites. However, cancer cells have evolved mechanisms against these immune checkpoints to downregulate T-cell activation and evade immune detection.4  \nImmune checkpoint inhibitors (ICIs) inhibit these negative regulatory components of the immune response targeted by tumour cells, like CTLA-4 and PD-1, leading to enhanced T-cell action against cancer cells.5 One specific agent, pembrolizumab, is a monoclonal antibody that binds to the PD-1 receptor on T-cells, impeding the interaction between the PD-1 receptor and its ligands (PD-L1 and PD-L2) expressed on tumour cells.1 Inhibiting  \nthe interaction between PD-1 and PD-L1 allows for T-cell activation, proliferation and cytotoxic secretion to produce antitumour immune responses.6  \nEnhancing the immune system can, however, lead to a unique constellation of inflammatory toxicities that may warrant discontinuation of therapy and/or administration of immunosuppressive agents.7 The broad activation can initiate unwanted autoimmune inflammation in patients, including a wide spectrum of vital organs such as the pituitary gland, thyroid gland, lungs, liver and kidneys.8 Infrequently, these adverse effects of ICIs can even present as severe complications, such as organ failure, which can ultimately be fatal, and are collectively termed immunerelated adverse events (irAEs).9 The onset of most irAEs is usually delayed, within weeks to months","cbCaigUeNTPnkPh7","https://ap.wps.com/l/cbCaigUeNTPnkPh7","pdf",768346,"English","# Summary\n## Background\n## Case presentation","[{\"question\":\"What problem does this case report focus on?\",\"answer\":\"It focuses on multiorgan failure caused by immune checkpoint inhibitor toxicity (irAEs) in a patient treated with pembrolizumab.\"},{\"question\":\"How did the patient present after starting pembrolizumab?\",\"answer\":\"After initiating pembrolizumab, she developed altered mental status with concern for stroke, including severe hypotension and abnormal neurologic findings.\"},{\"question\":\"Why is early suspicion of irAEs emphasized for ICI-treated patients?\",\"answer\":\"Because irAEs can be life-threatening, and early diagnosis and timely intervention are crucial to improve outcomes despite aggressive management challenges.\"}]","Management of multiorgan failure caused by immune checkpoint inhibitor toxicity | PDF",1790196336]