{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:55:12Z","timestamp":1774443312441,"version":"3.50.1"},"reference-count":16,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,18]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) block inhibitory pathways that tumour cells exploit to evade the immune system. They play a key role in the management of aggressive cancers, including non-small cell lung cancer, melanoma and Hodgkin\u2019s lymphoma. Despite their efficacy, ICIs can cause severe, potentially fatal, immune-related adverse events (irAEs), including multiorgan failure. We present a case of a woman in her early 70s with metastatic lung adenocarcinoma recently initiated on pembrolizumab who presented with an acute stroke complicated by irAE-related multiorgan failure. Despite aggressive treatment, the patient remained critically ill and passed away the same day after transitioning to end-of-life care. This case emphasises the life-threatening potential of irAEs, the importance of early diagnosis and the challenges of managing these complications. Clinicians should maintain a high index of suspicion for irAEs in ICI-treated patients to optimise timely intervention and outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2024-262209","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T17:45:58Z","timestamp":1739814358000},"page":"e262209","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Management of multiorgan failure caused by immune checkpoint inhibitor toxicity"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0268-1339","authenticated-orcid":false,"given":"Tushita","family":"Verma","sequence":"first","affiliation":[{"name":"Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6934-1047","authenticated-orcid":false,"given":"Altamash","family":"Jawadi","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shozab","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care, University of New Mexico, Albuquerque, New Mexico, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"2025082711424112000_18.2.e262209.1","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1159\/000518128","article-title":"Pembrolizumab Treatment-Induced Liver Toxicity","volume":"15","author":"Calderon","year":"2021","journal-title":"Case Rep Gastroenterol"},{"key":"2025082711424112000_18.2.e262209.2","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000239"},{"key":"2025082711424112000_18.2.e262209.3","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-021-06480-5"},{"key":"2025082711424112000_18.2.e262209.4","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0505802102"},{"key":"2025082711424112000_18.2.e262209.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1003466"},{"key":"2025082711424112000_18.2.e262209.6","doi-asserted-by":"crossref","first-page":"106","DOI":"10.21608\/secioj.2021.170554","article-title":"Expression of programmed death ligand-1 (PDL-1) in Acute Myeloid Leukemia Patients and its relation to post induction Response","volume":"9","author":"Abdel Hafeez","year":"2021","journal-title":"SECI Oncology J"},{"key":"2025082711424112000_18.2.e262209.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2013.245"},{"key":"2025082711424112000_18.2.e262209.8","article-title":"Immunotherapy: A Case Series","volume":"13","author":"Do","year":"2021","journal-title":"Cureus"},{"key":"2025082711424112000_18.2.e262209.9","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-019-0218-0"},{"key":"2025082711424112000_18.2.e262209.10","article-title":"Multiorgan Failure From Nivolumab and Ipilimumab: A Case Report and Literature Review","volume":"15","author":"Brazel","year":"2023","journal-title":"Cureus"},{"key":"2025082711424112000_18.2.e262209.11","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2020.569466","article-title":"Case Report: Fatal Multiorgan Failure and Heterochronous Pneumonitis Following Pembrolizumab Treatment in a Patient With Large-Cell Neuroendocrine Carcinoma of Lung","volume":"11","author":"Xie","year":"2020","journal-title":"Front Pharmacol"},{"key":"2025082711424112000_18.2.e262209.12","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2017.00049","article-title":"Current Diagnosis and Management of Immune Related Adverse Events (irAEs) Induced by Immune Checkpoint Inhibitor Therapy","volume":"8","author":"Kumar","year":"2017","journal-title":"Front Pharmacol"},{"key":"2025082711424112000_18.2.e262209.13","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21596"},{"key":"2025082711424112000_18.2.e262209.14","doi-asserted-by":"publisher","DOI":"10.14740\/jocmr3750"},{"key":"2025082711424112000_18.2.e262209.15","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01440"},{"key":"2025082711424112000_18.2.e262209.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.10.001"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-262209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:42:49Z","timestamp":1756320169000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-262209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,17]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2024-262209"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-262209","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}