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CASE REPORT article

Front. Oncol.

Sec. Pharmacology of Anti-Cancer Drugs

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1658621

This article is part of the Research TopicCase Reports in Autoimmune and Autoinflammatory Disorders: Volume IIView all 25 articles

A case report of malignant hypertension and multiorgan dysfunction during immunotherapy for gallbladder cancer

Provisionally accepted
Caroline  AnthonCaroline Anthon1Hugo  PierretHugo Pierret1Frederic  HoussiauFrederic Houssiau2Astrid  De CuyperAstrid De Cuyper1Cédric  Van MarckeCédric Van Marcke1Marc  Van Den EyndeMarc Van Den Eynde1Filomena  MazzeoFilomena Mazzeo1Frank  CornelisFrank Cornelis1Rachel  GalotRachel Galot1Francois  P DuhouxFrancois P Duhoux1Jean-François  BaurainJean-François Baurain1Emmanuel  SerontEmmanuel Seront1*
  • 1Medical oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
  • 2Rheumatology, Cliniques universitaires Saint-Luc, Brussels, Belgium

The final, formatted version of the article will be published soon.

We report the case of a 77-year-old woman with metastatic gallbladder cancer who initially received adjuvant capecitabine following surgery. During this period, she developed a facial rash, associated with a positive antinuclear antibody (ANA) with a titer of 1:320. Six months later, disease recurrence prompted treatment with gemcitabine, cisplatin, and durvalumab. Shortly after completing six cycles of chemo-immunotherapy, she presented with rapidly progressive dyspnea, severe hypertension, thrombotic microangiopathy (TMA; confirmed on renal pathology), and multiorgan dysfunction, including hepatic and muscular involvement. Laboratory workup revealed a strongly positive ANA titer (1:1280) corresponding to strongly positive anti-Th/To antibodies. Although the clinical presentation was highly suggestive of scleroderma renal crisis (SRC), it remained challenging to determine whether this was an immune-related adverse event, a paraneoplastic manifestation, or an exacerbation of a pre-existing autoimmune condition. This case illustrates the diagnostic and therapeutic complexity of autoimmune phenomena in oncology and highlights the importance of thorough autoimmune screening and multidisciplinary collaboration before and during immunotherapy.

Keywords: Immune checkpoint inhibitor, thrombotic microangiopathy, Scleroderma renalcrisis, Immune-related adverse event, systemic sclerosis

Received: 02 Jul 2025; Accepted: 30 Sep 2025.

Copyright: © 2025 Anthon, Pierret, Houssiau, De Cuyper, Van Marcke, Van Den Eynde, Mazzeo, Cornelis, Galot, Duhoux, Baurain and Seront. 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: Emmanuel Seront, emmanuel.seront@saintluc.uclouvain.be

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