Author(s)
Laurence Gascon
Sarah Benyo
Rebecca Chota Nelson
Affiliation(s)
Cleveland Clinic, Cleveland, OH;
Abstract:
Objective: To report a series of two cases of an unusual and life-threatening complication with immunotherapy
Method: Case series and review of literature
Results: We report two cases of significant supraglottic swelling and tracheitis in patients treated with immunotherapy. The first patient is a 62-year-old male receiving treatment for a stage 4 melanoma with nivolumab and relatlimab. He presented in otolaryngology clinic for subacute dysphonia and dysphagia. Flexible laryngoscopy findings showed significant airway edema, mucopurulent secretions, and inflammation. He was admitted inpatient and treated with high dose systemic steroids and intravenous antibiotics. His airway examination showed improvement with medical management. The patient was discharged with antibiotics and a steroid taper. Treatment with immunotherapy was put on hold due to this severe and potentially life-threatening complication. The second patient is a 76-year-old male with bladder cancer treated with pembrolizumab. Four months after beginning treatment, he experienced hoarseness and throat discomfort. His laryngoscopic examination showed diffuse supraglottic swelling. He was treated inpatient with steroids, antibiotics, and antifungals, which resulted in improvement of supraglottic swelling. He remained on his immunotherapy treatment. His supraglottis demonstrated persistent swelling without airway obstruction. Regarding airway-related complications with immunotherapy, the literature reports two other cases of tracheitis related to immune checkpoint inhibitors.
Conclusion: This is the first case series of supraglottitis in patients treated with immune checkpoint inhibitors. This adds to the emerging literature of immunotherapy side effects.