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Induction of Myasthenia Gravis, Myositis, and Insulin-Dependent Diabetes Mellitus by High-Dose Interleukin-2 in a Patient With Renal Cell Cancer

 

作者: Paula Fraenkel,   Seward Rutkove,   Jean Matheson,   Mary Fowkes,   Marie Cannon,   Mary-Elizabeth Patti,   Michael Atkins,   Jared Gollob,  

 

期刊: Journal of Immunotherapy  (OVID Available online 2002)
卷期: Volume 25, issue 4  

页码: 373-378

 

ISSN:1524-9557

 

年代: 2002

 

出版商: OVID

 

关键词: Interleukin-2;Autoimmunity;Myasthenia gravis;Renal cell cancer

 

数据来源: OVID

 

摘要:

Interleukin-2 is an effective agent against renal cell carcinoma and melanoma, but it has been associated with autoimmune sequelae such as hypothyroidism and vitiligo. A 64-year-old man with non-insulin-dependent diabetes and metastatic renal cell carcinoma developed insulin-dependent diabetes after his first cycle of therapy with high-dose (HD) interleukin-2. After additional therapy with interleukin-2, the patient developed generalized myasthenia gravis (MG) and polymyositis, both of which responded to treatment with corticosteroids and plasmapheresis. To investigate the role of IL-2 in the development of these autoimmune complications, autoantibody titers were assayed from serum obtained before and after IL-2 treatment and after treatment with corticosteroids plus plasmapheresis. Before IL-2 treatment, the patient had antibodies directed against insulin, islet cell antigens, and striated muscle. Acetylcholine receptor antibody levels were normal before starting IL-2. After treatment with IL-2, the patient developed acetylcholine receptor binding antibodies and exhibited an increase in the striated muscle antibody titer from 1:40 to 1:160. Recovery from the MG and polymyositis was associated with substantial decreases in the acetylcholine receptor and striated muscle antibody titers. These findings suggest that HD IL-2 accelerated the progression of latent autoimmune diabetes and myositis in this patient whose tolerance to islet cell antigens and striated muscle had already been broken and precipitated a break in tolerance to the acetylcholine receptor resulting in the development of MG. This case demonstrates the importance of prompt recognition of IL-2-induced MG and shows how this complication can be successfully managed with aggressive therapy.

 

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