title: Pembrolizumab-associated minimal change disease in a patient with malignant pleural mesothelioma.
abstract: Pembrolizumab is an anti- Programmed Death 1 (PD-1) antibody approved in melanoma, non-small cell lung cancer and investigated in malignant pleural mesothelioma. The most frequent immunotherapy related autoimmune reactions include dermatitis, pneumonitis, colitis, hypophysitis, uveitis, hypothyreodism, hepatitis and interstitial nephritis.
  
  
  
  We describe a 62-year old patient diagnosed with malignant pleural mesothelioma who experienced ten days after the second dose of third line therapy with pembrolizumab sudden onset of generalized edema including legs and eyelids and weight gain of 15 kg resulting from nephrotic syndrome and acute renal failure. Pembrolizumab was discontinued and prednisone, diuretics and angiotensin II receptor blocker were initiated with full recovery of symptoms and renal function. Pembrolizumab-associated minimal change disease (MCD) was confirmed by electron microscopy in the renal biopsy.
  
  
  
  We are the first to describe pembrolizumab-related minimal change disease (MCD). Physicians should be aware of this side effect in patients presenting with edema and weight gain and initiate prompt renal function testing, serum albumin and urinalysis followed by steroid treatment if pembrolizumab-related MCD is suspected.
authors.affiliation: Department of Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. angelika.bickel@kssg.ch.
authors.forename: Angelika
authors.initials: A
authors.lastname: Bickel
authors.affiliation: Division of Nephrology and Transplantation Medicine, Cantonal Hospital St.Gallen, St. Gallen, Switzerland.
authors.forename: Irene
authors.initials: I
authors.lastname: Koneth
authors.affiliation: Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Annette
authors.initials: A
authors.lastname: Enzler-Tschudy
authors.affiliation: Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Jörg
authors.initials: J
authors.lastname: Neuweiler
authors.affiliation: Department of Dermatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Flatz
authors.affiliation: Department of Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Früh
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C582435:pembrolizumab
keywords: Immunotherapy; Malignant Pleural Mesothelioma; Minimal change disease; PD-1 antibody; Pembrolizumab