Hemophagocytic lymphohistiocytosis and posterior reversible encephalopathy syndrome during BRAF/MEK inhibitor therapy following immune checkpoint blockade in metastatic melanoma: a case report

Rákkutatás · Melanoma · BRAF

Haemophagocytic lymphohistiocytosis (HLH) can occur as a rare but potentially fatal complication in patients with metastatic melanoma who receive sequential immune checkpoint inhibition followed by BRAF/MEK targeted therapy.

We report a 61‑year‑old woman with BRAF V600K‑mutant metastatic melanoma (stage IV) who initially underwent nivolumab and ipilimumab combination therapy, then progressed with immune‑related hypophysitis and received dabrafenib and trametinib. Shortly after starting targeted therapy the patient developed fever, rash, hemolysis, disseminated intravascular coagulation, acute kidney injury and evidence of Epstein–Barr virus reactivation. An HScore of 234 indicated a 98 % probability of HLH, and posterior reversible encephalopathy syndrome was confirmed on neuro‑imaging. Supportive care and immunosuppression led to gradual recovery. This case demonstrates that HLH and neuro‑toxicity are severe adverse events that can coexist in patients treated with sequential immunotherapy and BRAF/MEK inhibitors.

Early recognition of hyper‑inflammatory syndromes such as HLH in melanoma patients undergoing sequential immune checkpoint and targeted therapy is crucial, as timely immunosuppression can prevent irreversible organ damage and improve survival. This report highlights the need for vigilant monitoring and multidisciplinary management of such high‑risk adverse events during modern melanoma treatment regimens.

Bizonyítékszint: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.

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