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Table 3 Summary of case reports of digital ischemia and small vessel vasculitis with immune-check point inhibitors use

From: Acral vascular necrosis associated with immune-check point inhibitors: case report with literature review

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
  1. aMethotrexate, vinblastine, doxorubicin and cisplatin
  2. ASA acetylsalicylic acid, CCB calcium channel blockers