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Dimitrios Daoussis, Pantelis Kraniotis, Stamatis-Nick Liossis, Aikaterini Solomou, Immune checkpoint inhibitor-induced myo-fasciitis, Rheumatology, Volume 56, Issue 12, December 2017, Page 2161, https://doi.org/10.1093/rheumatology/kex369
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A 64-year-old Caucasian male was referred to the Rheumatology Clinic due to swelling and pain of his hands, knees and feet, gradually developed during the past month. He had a history of renal cell carcinoma and had been under immune checkpoint inhibitor (ICI) therapy in the form of nivolumab during the past 10 months. The patient was functionally impaired and reported a sense of ‘squeaking’ in his hands and feet. His wrists, knees and ankles were diffusely swollen but retained a good range of motion. Interestingly, a profound crepitus was noticed in all involved areas. An extensive laboratory workup was unremarkable apart from a moderately raised CRP. A complete serological profile including ANA, ENA, RF and ACPA was negative. ICI-induced arthritis was first suspected. However, the presence of crepitus suggested the involvement of periarticular structures and therefore a more detailed imaging in the form of MRI was ordered. MRI showed a symmetrical myo-fasciitis with associated tenosynovitis (Fig. 1). The patient received 12 mg of methylprednisolone and showed a dramatic clinical response within a few days.
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