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Perforation of small intestinal metastasis of lung adenocarcinoma treated with pembrolizumab : a case report

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Title: Perforation of small intestinal metastasis of lung adenocarcinoma treated with pembrolizumab : a case report
Authors: Sato, Shoki Browse this author
Senmaru, Naoto Browse this author
Ishido, Keita Browse this author
Saito, Takahiro Browse this author
Poudel, Saseem Browse this author →KAKEN DB
Muto, Jun Browse this author
Syouji, Yasuhito Browse this author
Hase, Ryunosuke Browse this author
Hirano, Satoshi Browse this author →KAKEN DB
Keywords: Pembrolizumab
Small intestinal perforation
Non-small cell lung carcinoma metastasis
Issue Date: 30-Oct-2019
Publisher: Springer (SpringerOpen)
Journal Title: Surgical case reports
Volume: 5
Issue: 1
Start Page: 166
Publisher DOI: 10.1186/s40792-019-0730-6
Abstract: Background: Pembrolizumab is an immune checkpoint inhibitor and is an anti-human programmed cell death-1 (PD-1) monoclonal antibody. Pembrolizumab is used for non-small cell lung carcinoma with high programmed cell death ligand-1 (PD-L1) expression. It has been found that better overall survival can be obtained using pembrolizumab compared to the existing chemotherapy. We report a case of perforation of small intestinal metastasis after pembrolizumab treatment. Case presentation: A 62-year-old man was treated by pembrolizumab for PD-L1 highly expressed lung adenocarcinoma, with multiple metastasis (small intestinal, lymph nodes, and bone). The treatment was stopped owing to drug-induced pneumonitis. One month after drug withdrawal, the patient visited the emergency department of our hospital with the complaint of severe stomachache. He had a rigid abdomen and generalized tenderness, and computed tomography scans showed free air within the abdomen. We diagnosed bowel perforation and performed emergency surgery. Surgical findings revealed multiple small intestine metastasis and mesenteric lymph node metastasis. Perforation was found in the metastatic site in the jejunum located around 40 cm anal to Treitz's ligament. This perforated part was resected, and functional end-to-end anastomosis was performed using linear staplers. The post-operative course was uneventful. Pathological examination revealed lung adenocarcinoma metastasis at the perforation site, and the effectiveness of pembrolizumab was grade 1b (Japanese Classification of the Colorectal Carcinoma, seventh edition). Conclusions: This is the first report of perforation of small intestinal metastasis of lung adenocarcinoma after pembrolizumab treatment. Because pembrolizumab causes some side effects, particularly autoimmune side effects, careful attention during treatment is warranted.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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