27 December 2018 : Case report
Development of Lobular Panniculitis Long After Completing the Personalized Peptide Vaccine Therapy
Unknown etiology, Mistake in diagnosis, Unusual or unexpected effect of treatment, Patient complains / malpractice, Adverse events of drug therapyAira Uchida1BDEF, Eiji Kawasaki1ADEF*, Masayuki Tojikubo1BD, Hidekazu Tamai1BD, Yoko Sagara1BD, Yuko Nakano1BD, Yoshitaka Uji2BD, Masanori Masuda3BD, Takahiro Yamaguchi4BD, Shigeru Yutani5BCD
Am J Case Rep 2018; 19:1530-1535
BACKGROUND: Personalized peptide vaccine therapy is regarded as a well-tolerated, safe and effective immunotherapy for patients with advanced cancers. Herein we report an exceptional case of a patient with advanced pancreatic cancer who developed delayed lobular panniculitis at sites corresponding to vaccine injections.
CASE REPORT: A 64-year-old Japanese female visited our clinic due to thirst and polydipsia; she was diagnosed as having type 2 diabetes. Simultaneously, she was diagnosed as having advanced pancreatic cancer; and a distal pancreatectomy and splenectomy were performed. Afterwards, she received adjuvant chemotherapy with titanium silicate-1 and personalized peptide vaccination using Montanide® ISA-51 by a subcutaneous injection to her abdomen over a total of 30 times. Thirteen months after the vaccine therapy had come to an end, lobular panniculitis appeared at the vaccination sites. At this point, corticosteroid was administered, resulting in significant improvement in the condition of the subcutaneous nodules.
CONCLUSIONS: This case report highlights the importance of careful patient explanation before initiation of cancer vaccine therapy about the possibilities of lobular panniculitis as an adverse event. It also highlights that it is important that physicians have a greater awareness of the possibility of panniculitis in patients with concerns regarding subcutaneous indurations even long after the end of peptide vaccine therapy.
Keywords: Adjuvants, Immunologic, Drug-Related Side Effects and Adverse Reactions, Panniculitis
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