Table 3 Summary of case reports of digital ischemia and small vessel vasculitis with immune-check point inhibitors use
Case | Age /Gender | Vascular Risk Factors | Malignancy | Medication | Symptoms | Duration before onset of symptoms | Treatment | Final Outcome |
|---|---|---|---|---|---|---|---|---|
Gambichler et al. [1] | 60/ Male | None | Metastatic Melanoma BRAF V600E Mutated | Ipilimumab + Nivolumab | Subungal necrosis followed by gangrene | 3 weeks | Prostacycline, methylprednisolone (50 mg in tapering dose), methylprednisolone 500 mg | Surgical amputation |
Padda et al. [7] | 52/ Female | None | Metastatic Melanoma | Ipilimumab | Digital Necrosis | 3 weeks | Amlodipine, Aspirin, Prednisone (60 mg), methyl prednisolone 500 mg, epoprostenol, Normal Saline, Rituximab | Surgical amputation |
Thoreau et al. [12] | 73/ Male | Diabetes | Metastatic Melanoma | Pembrolizumab | Acute ischemia of the left toes | 26 weeks | Iloprost, anticoagulation, amputation, aspirin, fogarty arterial embolectomy | Surgical amputation |
Comont et al. [8] | 66/ Male | Smoker | Urothelial Bladder Cancer | Tremelimumab + durvalumab/Chemotherapya | Periungal skin necrosis bilaterally | 20 weeks | Prednisone 1 mg/kg Immunotherapy discontinuation | Complete resolution |
Leburel et al. [5] | 60/Male | Not available | Melanoma | PD-L1 inhibitor+ BRAF and MEK inhibitors | Cyanosis of fingers, necrosis of 3 fingers and the heels, arthralgia, dry mouth, paresthesia of feet and interstitial pneumonia | 8.5 weeks | ICI withdrawal, prednisone 1 mg/kg, CCB, iloprost and ASA | Partial resolution |