A Case of Cytokine Release Syndrome (CRS) Related to Treatment With Lenvatinib Plus Pembrolizumab for Metastatic Clear Cell Renal Cell Carcinoma

IF 0.5 Q4 Medicine

IJU Case Reports Pub Date : 2026-08-07 DOI:10.1002/iju5.70228

Kei Nagase, Hiroaki Kakinoki, Kazuki Nakamura, Yukako Yamaguchi, Shuhei Kusano, Yuka Kakinoki, Maki Kawasaki, Kazuma Udo, Shohei Tobu, Mitsuru Noguchi

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Abstract

Introduction

Cytokine release syndrome (CRS) is a systemic inflammatory response triggered by various factors, including infection and immunotherapy. Due to its nonspecific presentation, distinguishing CRS from other life-threatening conditions remains challenging.

Case Presentation

A 79-year-old male receiving lenvatinib plus pembrolizumab for metastatic renal cell carcinoma presented with high-grade fever, altered mental status, and respiratory failure on day 4 of treatment. After excluding infectious etiologies and endocrine dysfunction, CRS was suspected and confirmed by elevated interleukin-6 levels. Lenvatinib and pembrolizumab were discontinued, and the patient was treated with tocilizumab and dexamethasone. Clinical improvement was achieved by day 7.

Conclusion

CRS should be considered a potential cause of unexplained shock in patients receiving immune checkpoint inhibitors. Early diagnostic consideration is vital for timely intervention.

Abstract Image

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Lenvatinib + Pembrolizumab治疗转移性透明细胞肾细胞癌相关细胞因子释放综合征（CRS） 1例

细胞因子释放综合征（CRS）是一种由感染和免疫治疗等多种因素引发的全身性炎症反应。由于其非特异性表现，将CRS与其他危及生命的疾病区分开来仍然具有挑战性。病例介绍：一名79岁男性接受lenvatinib + pembrolizumab治疗转移性肾细胞癌，在治疗的第4天出现高热、精神状态改变和呼吸衰竭。排除感染性病因和内分泌功能障碍后，白细胞介素-6水平升高，疑似CRS。停用Lenvatinib和pembrolizumab，患者接受tocilizumab和地塞米松治疗。第7天临床改善。结论：CRS应被认为是接受免疫检查点抑制剂的患者发生不明原因休克的潜在原因。早期诊断对于及时干预至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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