CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1585133
This article is part of the Research TopicImmune Tolerance Dual Role: Advancements in Cancer and Autoimmune DiseasesView all 9 articles
Tislelizumab-Induced Haemophagocytic Lymphohistiocytosis in a Patient with Microsatellite Instability-High Colon Cancer and Coexisting Systemic Lupus Erythematosus: a case report and literature review
Provisionally accepted- Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Immune checkpoint inhibitors (ICIs) have profoundly transformed the treatment landscape for microsatellite instability-high (MSI-H) colorectal cancer (CRC).However, immune-related adverse events (irAEs) remain a common and unpredictable complication among patients undergoing ICI therapy. Haemophagocytic lymphohistiocytosis (HLH), a rare and life-threatening irAE, is triggered by hyperactivated immune cells and excessive secretion of proinflammatory cytokines.We report a case of an MSI-H female patient with a history of systemic lupus erythematosus (SLE) who developed HLH after treatment with the anti-programmed cell death protein 1 (PD-1) antibody tislelizumab. After treated with tislelizumab 31 days, the patient presented with fever, pancytopenia, hemophagocytosis in bone marrow, elevated ferritin and triglyceride levels, and decreased fibrinogen. A diagnosis of HLH was confirmed with an H-score of 264. Despite steroid therapy, the patient's HLH progressed rapidly. Etoposide was deemed intolerable, and tocilizumab and immunoglobulin were declined due to financial constraints. Regrettably, the patient succumbed to HLH within 16 days of diagnosis. This is the first reported case of ICIinduced HLH in an MSI-H colon cancer patient with a history of SLE, prompting an analysis of the potential mechanisms underlying the induction of HLH in this case.Clinicians should be vigilant for the development of HLH during ICI treatment and initiate combination therapy as early as possible upon onset of HLH.
Keywords: MSI-H, PD-1, Colon Cancer, SLE, HLH
Received: 28 Feb 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Jiao, Wang, Wu, Zhao, Han and Sha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ziyue Sha, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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