Immunotherapy induced pyrexia and the role of PET/CT

Immunotherapy induced pyrexia and the role of PET/CT

Luke McLean, Jennifer A Soon, Andrew Haydon

Dept. Medical Oncology, The Alfred Hospital, Victoria, Melbourne, Australia

International-Journal-of-Case-Reports-2d code

Background: Immunotherapy has revolutionised the management of metastatic melanoma, however, immune-related adverse events remain an important complication of therapy. We hypothesise pyrexia is a rare presentation that may herald the development of immune-related toxicities and identify a potential role for fluorodeoxyglucose-positron emission tomography (FDG -PET) in the earlier diagnosis of these toxicities.
Case Presentation: We report a case of a 54-year-old man with metastatic melanoma, on combination immunotherapy with ipilumimab and nivolumab, where several days of fever heralded the development of clinical enterocolitis. He ultimately required treatment with infliximab with quick resolution of his symptoms. FDG- PET imaging performed as a work up for his pyrexia demonstrated extensive entero-proctocolitis and a follow up FDG-PET 3 months post infliximab demonstrated complete resolution of the entero-proctocolitis and ongoing complete extracranial response of the melanoma.
Conclusion: Early FDG-PET in patients with unexplained pyrexia on immunotherapy may help in an earlier diagnosis of immune-related toxicities allowing prompt initiation of therapy and a reduction in morbidity and mortality associated with these treatments.

Keywords: Immunotherapy, metastatic melanoma, immune-related adverse events, pyrexia, colitis, FDG-PET

Free Full-text PDF

How to cite this article:
Luke McLean, Jennifer A Soon, Andrew Haydon. Immunotherapy induced pyrexia and the role of PET/CT . International Journal of Case Reports, 2018 2:29. DOI: 10.28933/ijcr-2018-06-2901.


1. Australian Institute of Health and Welfare. Cancer in Australia 2017. Cancer series no 101. 2017;Cat. no. CAN 100.
2. Larkin J, Chiarion-Sileni V, Gonzalez R, Grob JJ, Cowey CL, Lao CD, et al. Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. New England Journal of Medicine. 2015;373(1):23-34.
3. Robert C, Schachter J, Long GV, Arance A, Grob JJ, Mortier L, et al. Pembrolizumab versus Ipilimumab in Advanced Melanoma. New England Journal of Medicine. 2015;372(26):2521-32.
4. Wolchok JD, Chiarion-Sileni V, Gonzalez R, Rutkowski P, Grob J-J, Cowey CL, et al. Overall Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma. New England Journal of Medicine. 2017;377(14):1345-56.
5. van der Hiel B, Blank CU, Haanen JB, Stokkel MP. Detection of early onset of hypophysitis by (18)F-FDG PET-CT in a patient with advanced stage melanoma treated with ipilimumab. Clin Nucl Med. 2013;38(4):e182-4.
6. Lyall A, Vargas HA, Carvajal RD, Ulaner G. Ipilimumab-induced colitis on FDG PET/CT. Clin Nucl Med. 2012;37(6):629-30.
7. Raad RA, Pavlick A, Kannan R, Friedman KP. Ipilimumab-induced hepatitis on 18F-FDG PET/CT in a patient with malignant melanoma. Clin Nucl Med. 2015;40(3):258-9.
8. Bacanovic S, Burger IA, Stolzmann P, Hafner J, Huellner MW. Ipilimumab-Induced Adrenalitis: A Possible Pitfall in 18F-FDG-PET/CT. Clin Nucl Med. 2015;40(11):e518-9.
9. Wachsmann JW, Ganti R, Peng F. Immune-mediated Disease in Ipilimumab Immunotherapy of Melanoma with FDG PET-CT. Acad Radiol. 2017;24(1):111-5.
10. Alabed YZ, Aghayev A, Sakellis C, Van den Abbeele AD. Pancreatitis Secondary to Anti-Programmed Death Receptor 1 Immunotherapy Diagnosed by FDG PET/CT. Clin Nucl Med. 2015;40(11):e528-9.

Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details)

CC BY 4.0
This work and its PDF file(s) are licensed under a Creative Commons Attribution 4.0 International License.