Progressive hypoventilation due to mixed CD8 + and CD4 + lymphocytic polymyositis following tremelimumab - durvalumab treatment

Progressive hypoventilation due to mixed CD8 + and CD4 + lymphocytic polymyositis following tremelimumab - durvalumab treatment:

Abstract

Background

The combination of CTLA-4 and PD-L1 inhibitors has a manageable adverse effect profile, although rare immune-related adverse events (irAE) can occur.

Case presentation

We describe an autoimmune polymyositis following a partial response to combination tremelimumab and durvalumab for the treatment of recurrent lung adenocarcinoma. Radiography revealed significant reduction in all metastases; however, the patient developed progressive neuromuscular hypoventilation due to lymphocytic destruction of the diaphragmatic musculature. Serologic testing revealed a low level of de novo circulating antibodies against striated muscle fiber. Immunohistochemistry revealed type II muscle fiber atrophy with a mixed CD8⁺ and CD4⁺ lymphocyte infiltrate, indicative of inflammatory myopathy.

Conclusions

This case supports the hypothesis that muscle tissue is a target for lymphocytic infiltration in immune checkpoint inhibitor-associated polymyositis. Further insights into the autoimmune mechanism of PM will hopefully contribute to the prevention and treatment of this phenomenon.

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