SUMMARY
We report the case of a 68-year-old man with a history of urothelial carcinoma treated by surgery followed by adjuvant therapy with nivolumab. Anti-PD-1 therapy was discontinued after eight months due to grade 3 skin toxicity treated with oral steroids. Two months after discontinuation, the patient presented with pancytopenia associated with hyperferritinaemia, hypertriglyceridemia, and coagulopathy, notably hypofibrinogenemia. A detailed workup suggested haemophagocytic lymphohistiocytosis (HLH) as the most likely diagnosis, and intravenous therapy with high-dose steroids was initiated. After six days of treatment, severe pancytopenia and coagulopathy remained unchanged. Immunosuppressive therapy was intensified by administering tocilizumab, an anti-IL6-receptor antibody. This treatment allowed full recovery of haematological parameters in eleven days, followed by rapid steroid tapering. This case highlights the efficacy of tocilizumab for the treatment of immune checkpoint-related HLH (irHLH).
BELG J MED ONCOL 2025;19(4):157–161)
