Rhabdomyolysis as a Predominant Multisystem Serious Immune-Related Adverse Event Induced by Sintilimab - A Case Report and Literature Review

Q: What immune-related adverse events were reported in the case after sintilimab treatment?

The report describes immune polymyositis with myocardium involvement and rhabdomyolysis, along with immune-associated hepatitis, thyrotoxicosis, and secondary hypoadrenalism.

Q: How was the patient treated after developing severe multisystem irAEs?

The patient received high-dose corticosteroid shock therapy, after which symptoms and indicators improved significantly.

Q: Why is monitoring important in patients receiving immune checkpoint inhibitors?

Multisystem irAEs can be rare and some manifestations may be insidious without corresponding clinical symptoms, so early indicator detection and monitoring help avoid missed diagnosis.

Sep 29, 2026

Uploaded by Melati

Cancer treatment has entered the era of immunotherapy, where immune checkpoint inhibitors can trigger immune-related adverse events (irAEs) affecting multiple organs. This case report describes immune polymyositis involving myocardium and rhabdomyolysis in a patient with lung adenocarcinoma with brain metastases treated using sintilimab. Additional simultaneous irAEs included immune-associated hepatitis, thyrotoxicosis, and secondary hypoadrenalism. After high-dose corticosteroid shock therapy, symptoms and clinical indicators improved substantially.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Case Presentation

Cancer Management and Research Open Access Full Text Article C ASE REPORT Rhabdomyolysis as a Predominant Multisystem Serious Immune-Related Adverse Event Induced by Sintilimab: A Case Report and Literature Review Qingyuan Duan, Xueying Zhang, Minjie Li Department of Radiotherapy, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China Correspondence: Minjie Li, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China, Email [liminjie0326@sina.com](liminjie0326@sina.com) | Abstract: Cancer treatment has entered the era of immunotherapy after surgery, radiotherapy, chemotherapy, and targeted therapy. The immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs) have become a significant concern in clinical practice, given the broad application of these agents. This article reports a case of immune polymyositis involving the myocardium and rhabdomyolysis in a patient with lung adenocarcinoma combined with brain metastases treated with sintilimab. In addition, there was simultaneous involvement of other systems with immune-associated hepatitis, thyrotoxicosis, and secondary hypoadrenalism. After high-dose corticosteroid shock therapy administration, the patient’s symptoms and indicators improved significantly.
Keywords: sintilimab, immune-related adverse events, rhabdomyolysis, immune-related myositis, secondary adrenal insufficiency, corticosteroids | | --- | | Introduction
Immune checkpoints are a class of negative regulatory proteins that inhibit the activity of immune cells. This phenomenon enables certain tumor cells to evade the immune system’s attack. Immune checkpoint inhibitors (ICIs) block down-regulation pathways, stimulating T-cell proliferation, and enhancing the body’s antitumor immunity. While activating antitumor immunity, ICIs may disrupt autoimmune homeostasis, leading to inflammatory toxicities that can affect nearly all systems and organs. These reactions are defined as immune-related adverse events (irAEs), with the skin, gastrointestinal tract and liver being the most frequently affected systems.1 While neuromuscular irAEs occur in <6% of patients, and ICI-associated myocarditis is reported at a frequency of 0.27% to 1. 14% .2 The occurrence of multisystem irAEs is much rarer. The present case report concerns a patient with brain metastases from lung adenocarcinoma who developed severe irAEs in multiple systems manifested by rhabdomyolysis after sintilimab, some of which were very insidious in that the patient did not have corresponding clinical symptoms despite the involvement of some systems. To avoid missed diagnosis and facilitate early diagnosis, clinical indicators should be detected promptly, and patients should be monitored for the possibility of multisystem involvement. Our case provides experience and reference for clinical diagnosis and treatment.
Case Presentation
A 55-year-old woman was diagnosed with lung adenocarcinoma in 2022, and genetic testing revealed an epidermal growth factor receptor (EGFR) mutation. She underwent interventional embolization of a lesion in her right lung and received eight cycles of chemotherapy with Pemetrexed. Following that, she received treatment with Gefitinib, a targeted therapy. The patient’s condition demonstrated stability during the period of review. On January 31, 2024, the cranial MRI revealed occupancy in the right frontal lobe and cerebellar hemisphere accompanied by peripheral cerebral parenchymal | Received: 8 September 2025 Accepted: 21 December 2025 Published: 31 December 2025 Cancer Management and Research 2025:17 3383–3392 3383 © 2025 Duan et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at [https://www.dovepress.com/terms.php](https://www.dovepress.com/terms.php) and incorporate the Creative Commons Attribution – Non Commercial (unported,

FAQs

What immune-related adverse events were reported in the case after sintilimab treatment?

The report describes immune polymyositis with myocardium involvement and rhabdomyolysis, along with immune-associated hepatitis, thyrotoxicosis, and secondary hypoadrenalism.

How was the patient treated after developing severe multisystem irAEs?

The patient received high-dose corticosteroid shock therapy, after which symptoms and indicators improved significantly.

Why is monitoring important in patients receiving immune checkpoint inhibitors?

Multisystem irAEs can be rare and some manifestations may be insidious without corresponding clinical symptoms, so early indicator detection and monitoring help avoid missed diagnosis.

Sep 29, 2026

Uploaded by Melati