Pulse-dose steroids rapidly resolved a novel, life-threatening Lupus-like reaction with hyperpyrexia (107°F) and recurrent serositis in a patient post-CAR-T therapy.
Case Report (n=1)
CAR-T therapy can cause a severe, late-onset Lupus-like reaction with critical hyperpyrexia and serositis that is responsive to pulse-dose steroids.
Abstract Background 40 year-old woman with medical history of Hodgkin’s lymphoma in remission status post CAR-T May 2024, nonischemic cardiomyopathy with EF of 25-30%, interstitial lung disease, recurrent gallstone pancreatitis, known PJP on treatment, and recent hospitalization for serositis who was admitted to the ICU for acute respiratory distress syndrome (ARDS) and developed acute Lupus-like reaction with fever of 107. Case Report The patient was admitted to the Medical Intensive Care Unit (MICU) and had been intubated for ARDS. She was treated with appropriate steroids for ARDS. After her last day of steroids, she developed increasing fevers with peak of 107, sinus tachycardia to 160s, and worsening vent settings. Her EKG showed diffuse ST elevation and ultrasound showed pericardial effusion. She was hemodynamically unstable and developed two-pressor shock. Febrile workup was negative for any new infection including viral, fungal, and bacterial. The fever did not respond to Tylenol, ambient cooling measures, or broad-spectrum antibiotics. Inflammatory markers were severely elevated. She was given pulse-dose steroids and her temperature returned to normothermic within 12 hours. The etiology was thought to be a Lupus-like reaction secondary to CAR-T therapy as the patient had developed serositis causing pancreatitis, pericarditis, and pleural effusion, leukopenia, anemia, and acute kidney injury (AKI). After steroid administration she rapidly recovered and was able to be extubated. Her AKI, pericarditis, and pleural effusion rapidly improved with pulse-dose steroid administration. Management and Outcome the patient was treated as a Lupus-flare with a long steroid taper and close outpatient follow-up. She was discharged with Mycophenolate. After discharge she was seen by Oncology who prescribed IVIG infusions to manage ongoing serositis concerns. Her Mycophenolate was switched to Jakafi. She unfortunately developed chronic respiratory failure while on her steroid taper and required ongoing 2L O2 for dyspnea. She continues to follow outpatient with Pulmonology and Oncology. Discussion CAR-T therapy is a new treatment for multiple cancers, and the long-term effects are still being researched. Currently it is known that CAR-T can cause cytokine storm shortly after therapy, however there are no case reports detailing development of Lupus-like reaction in response to unrelated illness or insult. This case details a novel long-term side effect of CAR-T therapy not previously published. It is relevant for the Pulmonary and Critical Care Physician as many cancer patients are admitted to the Medical Intensive Care Unit, and this reaction is essential to keep on the differential for these patients. This abstract is funded by: None
Hunting et al. (Fri,) conducted a case report in CAR-T induced recurrent serositis and hyperpyrexia (Lupus-like reaction) (n=1). Pulse-dose steroids was evaluated. Pulse-dose steroids rapidly resolved a novel, life-threatening Lupus-like reaction with hyperpyrexia (107°F) and recurrent serositis in a patient post-CAR-T therapy.