Cytokine release syndrome
following COVID‐19 infection during treatment
with nivolumab for cancer of esophagogastric
junction carcinoma: a case report and review
Dublin Core
Title
Cytokine release syndrome
following COVID‐19 infection during treatment
with nivolumab for cancer of esophagogastric
junction carcinoma: a case report and review
following COVID‐19 infection during treatment
with nivolumab for cancer of esophagogastric
junction carcinoma: a case report and review
Subject
Immune-related adverse event, Cytokine release syndrome, Immune checkpoint inhibitor
Description
Abstract
Background Cytokine release syndrome (CRS) is an acute systemic inflammatory syndrome characterized by fever
and multiple organ failure, which is triggered by immunotherapy or certain infections. Immune checkpoint inhibitors
rarely cause immune-related adverse event- cytokine release syndrome (irAE-CRS). This article presents a case report
of irAE-CRS triggered by coronavirus disease 2019 (COVID-19).
Case presentation A 60-year-old man with type 2 diabetes received nivolumab treatment for esophagogastric junc-
tion carcinoma and experienced two immune-related adverse events: hypothyroidism and skin disorder. Eleven days
before his visit to our hospital, he had a fever and was diagnosed with COVID-19. Five days before his visit, he devel-
oped a fever again, along with general malaise, water soluble diarrhea, and myalgia of the extremities. On admission,
the patient was in a state of multiple organ failure, and although the source of infection was unknown, a tentative
diagnosis of septic shock was made. The patient’s condition was unstable despite systemic management with antimi-
crobial agents, high-dose vasopressors, and intravenous fluids. We suspected CRS due to irAE (irAE-CRS) based on his
history of nivolumab use. Steroid pulse therapy (methylprednisolone 1 g/day) was started, and the patient temporarily
recovered. However, his respiratory condition worsened; consequently, he was placed on a ventilator and tocilizumab
was added to the treatment. His muscle strength recovered to the point where he could live at home, and was subse-
quently discharged.
Conclusion In patients previously treated with immune checkpoint inhibitors, irAE-CRS should be considered
as a differential diagnosis when multiple organ damage is observed in addition to inflammatory findings. It is recom-
mended to start treatment with steroids; if the disease is refractory, other immunosuppressive therapies such as tocili-
zumab should be introduced as early as possible.
Keywords Immune-related adverse event, Cytokine release syndrome, Immune checkpoint inhibitor
Background Cytokine release syndrome (CRS) is an acute systemic inflammatory syndrome characterized by fever
and multiple organ failure, which is triggered by immunotherapy or certain infections. Immune checkpoint inhibitors
rarely cause immune-related adverse event- cytokine release syndrome (irAE-CRS). This article presents a case report
of irAE-CRS triggered by coronavirus disease 2019 (COVID-19).
Case presentation A 60-year-old man with type 2 diabetes received nivolumab treatment for esophagogastric junc-
tion carcinoma and experienced two immune-related adverse events: hypothyroidism and skin disorder. Eleven days
before his visit to our hospital, he had a fever and was diagnosed with COVID-19. Five days before his visit, he devel-
oped a fever again, along with general malaise, water soluble diarrhea, and myalgia of the extremities. On admission,
the patient was in a state of multiple organ failure, and although the source of infection was unknown, a tentative
diagnosis of septic shock was made. The patient’s condition was unstable despite systemic management with antimi-
crobial agents, high-dose vasopressors, and intravenous fluids. We suspected CRS due to irAE (irAE-CRS) based on his
history of nivolumab use. Steroid pulse therapy (methylprednisolone 1 g/day) was started, and the patient temporarily
recovered. However, his respiratory condition worsened; consequently, he was placed on a ventilator and tocilizumab
was added to the treatment. His muscle strength recovered to the point where he could live at home, and was subse-
quently discharged.
Conclusion In patients previously treated with immune checkpoint inhibitors, irAE-CRS should be considered
as a differential diagnosis when multiple organ damage is observed in addition to inflammatory findings. It is recom-
mended to start treatment with steroids; if the disease is refractory, other immunosuppressive therapies such as tocili-
zumab should be introduced as early as possible.
Keywords Immune-related adverse event, Cytokine release syndrome, Immune checkpoint inhibitor
Creator
Takahisa Niimoto1,2*, Takafumi Todaka1
, Hirofumi Kimura1
, Shotaro Suzuki2
, Shumpei Yoshino2
,
Kosuke Hoashi3 and Hirotaka Yamaguchi1
, Hirofumi Kimura1
, Shotaro Suzuki2
, Shumpei Yoshino2
,
Kosuke Hoashi3 and Hirotaka Yamaguchi1
Source
https://doi.org/10.1186/s12245-024-00691-5
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Takahisa Niimoto1,2*, Takafumi Todaka1
, Hirofumi Kimura1
, Shotaro Suzuki2
, Shumpei Yoshino2
,
Kosuke Hoashi3 and Hirotaka Yamaguchi1, “Cytokine release syndrome
following COVID‐19 infection during treatment
with nivolumab for cancer of esophagogastric
junction carcinoma: a case report and review,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12410.
following COVID‐19 infection during treatment
with nivolumab for cancer of esophagogastric
junction carcinoma: a case report and review,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12410.