Metastatic lesions in the joint associated with acute inflammatory arthritis after dendritic cell immunotherapy for metastatic melanoma.
A 47 year old man undergoing immunotherapy for metastatic melanoma with autologous dendritic cells pulsed with autologous tumour peptide and hepatitis B surface antigen developed acute left ankle arthritis. Gout and acute infection were excluded, and an autoimmune aetiology or occult metastasis were considered. The arthritis initially subsided with indomethacin, but the symptoms recurred 2 months later, and magnetic resonance imaging demonstrated metastatic melanoma of the left talus. Immunohistochemical staining of a cerebral metastatic deposit biopsied 1 week after the onset of arthritis demonstrated T-cell and macrophage infiltration of the tumour. In addition, the patient developed melanoma-specific delayed type hypersensitivity and cytotoxic T-cell responses after vaccination. Thus, the monoarthritis represented an 'appropriate' inflammatory response directed against metastatic melanoma.
Thomas
R
R
Center for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia. rthomas@medicine.pa.uq.edu.au
Padmanabha
J
J
Chambers
M
M
McFadyen
S
S
Walpole
E
E
Nielssen
G
G
Smithers
M
M
D001168:Arthritis / Q000150:complications*; D017252:CD3 Complex / Q000096:biosynthesis; D016827:CD8 Antigens / Q000096:biosynthesis; D019496:Cancer Vaccines; D003713:Dendritic Cells / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007167:Immunotherapy; D007592:Joint Diseases / Q000150:complications* / Q000378:metabolism* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000150:complications* / Q000378:metabolism / Q000628:therapy*; D008875:Middle Aged
D017252:CD3 Complex; D016827:CD8 Antigens; D019496:Cancer Vaccines