Mupirocin Pemphigus-Like Drug Reaction in a Dog

Background: Pharmacodermia is defined as adverse reaction in skin, mucosa and appendages, which generates morpho-functional alterations in cutaneous barrier, inducing autoimmune diseases, such as pemphigus foliaceous, which is known as the most common autoimmune skin disease in dogs. This disease involves autoantibodies against desmoglein and desmocolin molecules, being induced by the use of certain drugs. Mupirocin (pseudomonic acid A) is a broad-spectrum antibiotic with bacteriostatic activity, being effective against Gram-positive pathogens and used to control superficial bacterial folliculitis. Based on that, the aim of this study was to report a pemphigus-like lesions after topical use of mupirocin in dog.Case: An 1-year-old, uncastrated male, Poodle dog, weighing 13.8 kg was treated in a private clinic in Fortaleza. The main complaint was related to pruritus in abdominal and inguinal region, in addition of legs licking. Dermatological examination revealed melanic crusts, epidermal collars and diffuse pustules in inguinal, abdominal, perianal and thoraco-lumbar regions. The therapy was based on topical use of Mupirocin in form of 0.2% aquous spray. After drug administration, the animal presented urticaria, diffuse epidermal collars, papulo-crusted and pustular lesions, which were more evident in abdominal and inguinal region. Nasal erythema, binocular blepharitis, apathy and fever were also observed. Cytological examination and bacterial culture were performed, revealing inflammatory and acantholytic cells and no bacterial growth. Biopsy procedure revealed subcorneal pustule with presence of epithelial acantholytic cells and neutrophils, compatible with canine pemphigus foliaceous. The topical treatment of ocular lesions with 0.1% Tacrolimus associated with systemic treatment with high dose of prednisolone (1.2 mg kg-1). The patient improved the dermatological clinical signs, however, some side effects have already become evident, such as the presence of telangiectasia, polyuria, polyphagia and polydipsia. Heterodox therapy based on the use of azathioprine (2 mg kg-1) was chosen in order to reduce corticoid dose. After 3 days of therapy, blood material was collected for hepatic evaluation, detecting hepatotoxicity. From the results, azathioprine therapy was suspended, and only high-dose corticosteroid therapy (1.5 mg kg-1) was maintained. The patient presented a considerable improvement in the lesion after 10 days of treatment.Discussion: There have been reports that pharmacodermic reactions may be associated with the development of autoimmune diseases, such as pemphigus foliaceus and vulgaris. In some cases, the lesions regress after drug discontination. In others, the medication acts as a triggering factor, activating the genetic predisposition of patient, which develops the pathology even after therapy interruption. The drug related pemphigus-foliaceous is a well-recognized disease in humans, however this disease is limited to sporadic cases in dogs. The therapy was based in use of a high dose of prednisolone, which caused some side effects. Therefore, a heterodox therapy was chosen in order to reduce the corticoid dosage. At the first hemato-biochemical evaluation, the patient already presented significant alterations, being requested to suspend the prescribed treatment, although the owners already reported improvement of the dermatological lesions. Due to this, a higher dose of prednisolone was chosen, obtaining the best response among the therapies used since the beginning of the treatment. After clinical improvement, the gradual reduction of steroidal therapy was started in order to avoid side effects related to suppression of the hypothalamic-pituitary-adrenal axis. This report provides evidences of Mupirocin as a potential triggering factor of pemphigus-like lesions in dogs.

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Pemphigus Foliaceous in a Dog - Clinical and Laboratorial Assessment

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.105171 ◽

2020 ◽

Vol 48 ◽

Author(s):

Virgínia Pereira Monteiro ◽

Alexandre Tavares Camelo Oliveira ◽

Tiago Cunha Ferreira

Keyword(s):

Side Effects ◽

Autoimmune Diseases ◽

Inflammatory Process ◽

Leukocyte Count ◽

Neutrophil To Lymphocyte Ratio ◽

Total Leukocyte Count ◽

High Dose ◽

Lymphocyte Ratio ◽

Days Of Therapy

Background: The pemphigus complex is defined as a group of blistering autoimmune diseases that affects skin and mucous membrane. Pemphigus foliaceous is the most common disease in this group, being characterized by the production of autoantibodies against keratinocyte adhesion molecules. The treatment is based on the use of immunosuppressive drugs and requires constant monitoring to assess inflammatory control as well as side effects of therapy. Based on that, the aim of this study was to report the clinical and laboratorial follow-up of a canine with pemphigus foliaceous.Case: An 11-year-old male neutered mongrel dog, weighing 9.8 kg, was presented with a main complaint related to disseminated pruritus and lesions in face, trunk and limbs. Dermatological examination revealed meliceric crusts, epidermal collars and diffuse pustules in inguinal, abdominal, face, limbs, ears and thoraco-lumbar regions. Cytological examination was performed, revealing inflammatory and acantholytic cells and absence of bacterial cells. Biopsy procedure revealed subcorneal pustule with presence of epithelial acantholytic cells and neutrophils, compatible with canine pemphigus foliaceous. Hemoto-biochemical analysis revealed a leukocytosis due to increased neutrophil count. Systemic treatment with high dose of prednisolone (2.0 mg/kg) and azathioprine (2.5 mg/kg) was proposed, while topical therapy with a 3% chlorhexidine shampoo was used to prevent secondary bacterial infections. The patient improved the dermatological clinical signs, being possible to observe a reduction of systemic and tissue inflammatory process. After 90 days of therapy, there was a partial loss of hair body coverage, associated with follicular lesions, and after 180 days of therapy it was possible to notice a new hair mantle, without visible areas of inflammation.Discussion: The described clinical case demonstrates the clinical and laboratorial follow-up of a patient with naturally occurring canine pemphigus foliaceus. The main clinical characteristic of this disease is the formation of generalized pustular lesions, affecting regions such as the head, ear pinnae and limbs, which induced the diagnostic suspicion in the reported patient, in addition to the clinical history associated with complementary exams. In tissue evaluation, a pyogranulomatous inflammatory process was observed, with a marked presence of neutrophils and macrophages, which migrate from the dermis towards the epidermis. In systemic leukocyte analysis, an increase in the total leukocyte count was observed, due to the increase in circulating neutrophils. The therapy was based in use of a high dose of prednisolone associated with azathioprine. The following hemato-biochemical evaluations revealed a gradual reduction of systemic inflammatory process. Attention is drawn to neutrophil to lymphocyte ratio, which is a low-cost biomarker and less sensitive to pathophysiological changes when compared to individual leukocyte count. This parameter has been gaining visibility as a potential method of monitoring chronic inflammatory diseases. In veterinary medicine, its use is limited, with no reports related to canine pemphigus foliaceous in Brazil. After clinical and hematological improvement, prednisolone dose was slowly reduced, in order to avoid side effects. After clinical improvement, only azathioprine was maintained, in order to prevent critical flares. This report provides a clinical and laboratorial follow-up of a canine with pemphigus foliaceous, as well as it is the first one to describe the use of neutrophil to lymphocyte ratio to monitor therapeutic progression. New studies and reports involving this biomarker in autoimmune diseases monitoring are encouraged.

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Activated and Expanded T Cells for Potential Therapy of Patients with Autoimmune Diseases.

Blood ◽

10.1182/blood.v104.11.3854.3854 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3854-3854

Author(s):

Alice Long ◽

Mark Bonyhadi ◽

Christophe Ferrand ◽

Mark Frohlich ◽

Ronald J. Berenson

Keyword(s):

T Cells ◽

Immune System ◽

T Cell ◽

Side Effects ◽

Autoimmune Diseases ◽

Current Therapy ◽

High Dose ◽

Autoreactive T Cells ◽

Repertoire Analysis ◽

Tcr Repertoire

Abstract Autoreactive T cells have been implicated as central players in many autoimmune diseases. Current therapy for autoimmune diseases involves chronic immunosuppression, which increases the risk of infection and cancer, and is associated with other side effects. Recently, high-dose chemotherapy combined with stem cell transplantation has been used, but is often associated with severe toxicities. To avoid the side effects associated with these therapies, we are developing an alternative therapeutic approach in which patients are treated with relatively non-toxic therapy to reduce T cell numbers, and then administered healthy T cells to restore the immune system. Most autoimmune patients have oligoclonal populations of T cells as measured by T cell receptor (TCR) repertoire analysis. These may represent autoreactive T cells which contribute to TCR repertoire skewing. Clinical studies have shown a positive correlation between post-therapy TCR repertoire normalization and remission of autoimmune diseases. We have developed the Xcellerate™ Technology for the ex vivo activation and expansion of T cells. To expand T cells, peripheral blood mononuclear cells (PBMCs) are cultured with microscopic paramagnetic beads conjugated with anti-CD3 and anti-CD28 mAbs (Xcyte™Dynabeads®). T cells manufactured using this or a similar technology have been administered to patients with cancer and HIV in several clinical trials. In these studies, we and others have shown that the Xcellerate Technology can normalize skewed TCR repertoires in these patient populations. In the present study, we evaluated the use of the Xcellerate Technology to grow T cells from patients with autoimmune diseases such as rheumatoid arthritis, scleroderma, Crohn’s disease and systemic lupus erythematosus. We collected data on cytokine secretion, activation marker expression, cell expansion and TCR repertoire. T cells expanded an average of 1,325 fold (±1,592; range=16–6,532; n=35 patients), with nearly all cultures displaying marked CD25 and CD154 upregulation, and secretion of high levels of IFNγ and GM-CSF. Similar to results observed in cancer patients, TCR repertoire analysis showed that the Xcellerate Technology can normalize the skewed repertoires observed in autoimmune patients. Out of 12 PBMCs examined by spectratype analysis, one showed no TCR Vβ skewing prior to expansion, whereas the remaining 11 tissues displayed varying degrees of skewedness. After expansion, repertoire skewedness was decreased for all 11 samples. Repertoire normalization was dependent upon high-levels of TCR/CD28 engagement, which was achieved by initiating cultures using high bead to T cell ratios (Figure 1). Neither type of autoimmune disease, disease severity nor patient treatment (including: steroids, melphalan, infliximab, rapamycin, etc.) at the time of blood collection had an adverse effect on the ability to expand the patients’ T cells. Based on these results, the Xcellerate Technology may prove useful for generating healthy T cells from patients with autoimmune diseases which could then be used to restore the immune system following lymphoablative therapy. Studies are underway to further evaluate this approach. Figure Figure

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Early recurrence or persistence of autoimmune diseases after unmanipulated autologous stem cell transplantation

Blood ◽

10.1182/blood.v88.9.3621.bloodjournal8893621 ◽

1996 ◽

Vol 88 (9) ◽

pp. 3621-3625 ◽

Cited By ~ 143

Author(s):

HH Euler ◽

AM Marmont ◽

A Bacigalupo ◽

S Fastenrath ◽

P Dreger ◽

...

Keyword(s):

Stem Cell ◽

Autoimmune Disease ◽

Stem Cell Transplantation ◽

Autoimmune Diseases ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Lupus Erythematosus ◽

Clinical Signs ◽

High Dose

Autologous stem cell transplantation with or without in vitro lymphocyte depletion has been suggested as a new treatment option for severe autoimmune diseases. We describe five patients with autoimmune diseases (CREST syndrome, myasthenia gravis and Hashimoto's thyroiditis, systemic lupus erythematosus, atopic dermatitis, and rheumatoid arthritis) who underwent autologous bone marrow (n = 1) or peripheral blood progenitor cell (n = 4) transplantation with unmanipulated grafts as treatment for the autoimmune disease in one case or as treatment for a malignant disorder with a concomitant autoimmune disorder in four cases. In all patients serological and clinical signs of the autoimmune disease recurred early or persisted. These observations should be regarded as a cautionary note concerning the efficacy of high-dose therapy followed by transplantation of unmanipulated autologous stem cells for treatment of severe autoimmune diseases.

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Bortezomib in antibody-mediated autoimmune diseases (TAVAB): study protocol for a unicentric, non-randomised, non-placebo controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-024523 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024523 ◽

Cited By ~ 10

Author(s):

Siegfried Kohler ◽

Stefanie Märschenz ◽

Ulrike Grittner ◽

Tobias Alexander ◽

Falk Hiepe ◽

...

Keyword(s):

Side Effects ◽

Autoimmune Diseases ◽

Lupus Erythematosus ◽

Case Reports ◽

Controlled Trial ◽

Neuropsychological Testing ◽

Significant Proportion ◽

Clinical Signs ◽

Specific Treatment ◽

Experimental Models

IntroductionThe clinical characteristics of autoantibody-mediated autoimmune diseases are diverse. Yet, medical treatment and the associated complications are similar, that is, the occurrence of long-term side effects and the problem that a significant proportion of patients are non-responders. Therefore, new therapeutic options are needed. Bortezomib, a proteasome inhibitor, is effective in the treatment of multiple myeloma and data from experimental models and case reports suggest an effect in the treatment of autoantibody-mediated autoimmunity. In our study, we will determine the effect of bortezomib treatment on a shared surrogate parameter for clinical efficacy, namely change in autoantibody levels, which we chose as primary parameter.Methods and analysisWe designed a phase IIa trial with altogether n=18 treatment-refractory patients suffering from myasthenia gravis, systemic lupus erythematosus and rheumatoid arthritis that will be treated with bortezomib add-on to pre-existing therapy. Primary endpoint is the change in autoantibody levels 6 months after therapy. Secondary endpoints include concomitant medication, disease-specific clinical scores and measures of quality of life and activities of daily living.Ethics and disseminationSafety parameters include neurophysiological and clinical signs of peripheral neuropathy as well as potential central nervous system side effects determined by olfactory and neuropsychological testing. The study has been approved by the local ethical committee and first participants have already been enrolled. This proof of concept study will contribute to improve our understanding of plasma cell-specific treatment approaches by assessing its safety and efficacy in reducing serum levels of antibodies known to mediate autoimmune disorders.We plan to publish the final results of our study in a peer reviewed journal and to present our findings at international conferences.Trial registration numberNCT02102594.

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Refractory Anaphylactic Shock Associated with Ketoconazole Treatment

Annals of Pharmacotherapy ◽

10.1345/aph.1e465 ◽

2005 ◽

Vol 39 (3) ◽

pp. 547-550 ◽

Cited By ~ 5

Author(s):

Ping-Yen Liu ◽

Cheng-Han Lee ◽

Li-Jen Lin ◽

Jyh-Hong Chen

Keyword(s):

Anaphylactic Shock ◽

Good Condition ◽

Clinical Signs ◽

Vital Signs ◽

High Dose ◽

Severe Reaction ◽

Epinephrine Infusion ◽

Severe Hypotension ◽

Days Of Therapy ◽

High Level

OBJECTIVE: To report a rare but severe reaction of refractory anaphylactic shock with ketoconazole treatment—associated hypotensive episodes in an elderly patient. CASE SUMMARY: A 72-year-old woman received antifungal therapy for her almost completely occluded cornea infected with Candida albicans. She was initially prescribed oral ketoconazole 200 mg twice daily. She developed hypotension over the first 2 days of therapy (BP 136/82 mm Hg at baseline; 90/50 mm Hg on day 2). Severe hypotension (BP 90/49 mm Hg) unresponsive to fluid therapy or high-dose dopamine developed on day 4 of therapy. An invasive Swan—Ganz catheterization study showed a very low level of peripheral vascular resistance with high cardiac output index without clinical signs of infection. When laboratory tests showed a high level of plasma tryptase, anaphylactic redistribution shock was diagnosed. Her vital signs became more stable after treatment with hydrocortisone and epinephrine infusion. She was discharged in good condition after 24 hours of observation. DISCUSSION: As of December 2004, refractory anaphylactic shock resulting from ketoconazole use had not been reported. The events of hypotension were strongly associated with the intake of ketoconazole. The hemodynamic results obtained with Swan—Ganz catheterization were compatible with anaphylactic shock. The Naranjo probability scale showed a probable association of the adverse event with ketoconazole. CONCLUSIONS: Ketoconazole may cause severe anaphylactic shock even when taken orally. Invasive catheterization and elevated tryptase levels can provide important information in the management of anaphylactic shock.

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Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661195 ◽

1984 ◽

Vol 52 (03) ◽

pp. 276-280 ◽

Cited By ~ 17

Author(s):

Sam Schulman ◽

Dieter Lockner ◽

Kurt Bergström ◽

Margareta Blombäck

Keyword(s):

Deep Vein Thrombosis ◽

Oral Anticoagulation ◽

Dose Group ◽

Low Dose ◽

Clinical Signs ◽

Coagulation Factor ◽

High Dose ◽

Vein Thrombosis ◽

Heparin Treatment ◽

Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

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Immune Thrombocytopenia in an Adolescent with Hashimoto’s Thyroiditis – Case Report

Journal of Interdisciplinary Medicine ◽

10.2478/jim-2019-0018 ◽

2019 ◽

Vol 4 (3) ◽

pp. 145-149 ◽

Cited By ~ 1

Author(s):

Izabella Kelemen ◽

Zsuzsanna Erzsébet Papp ◽

Mária Adrienne Horváth

Keyword(s):

Platelet Count ◽

Autoimmune Diseases ◽

Hashimoto’S Thyroiditis ◽

Clinical Signs ◽

Immunoglobulin Therapy ◽

Peripheral Blood Smear ◽

Bleeding Complications ◽

Hashimoto's Thyroiditis ◽

Line Treatment ◽

First Line

Abstract Introduction: In childhood, thrombocytopenia caused by transient antibody-mediated thrombocyte destruction is most frequently diagnosed as immune thrombocytopenic purpura (ITP). We report the case of a girl with ITP associated with autoimmune thyroiditis. Case presentation: A 11-year-old female patient with Hashimoto’s thyroiditis presented with clinical signs of petechiae and ecchymoses on the extremities. Laboratory tests showed remarkable thrombocytopenia with a platelet count of 44,500/μL, hence she was referred to a hematologic consultation. The peripheral blood smear showed normal size platelets in very low range. The bone marrow examination exposed hyperplasia of the megakaryocyte series with outwardly morphologic abnormalities. The patient was diagnosed with ITP, and her first-line treatment was pulsed steroid and immunoglobulin therapy. The thrombocytopenia was refractory to these first-line medications. After 6 months of corticotherapy and a period of severe menorrhagia, azathioprine immunosupression was initiated as a second-line treatment. Her platelet count rapidly increased, and the evolution was good, without bleeding complications. Conclusion: In case of a medical history of autoimmune diseases and treatment-resistant ITP, attention must be focused on detecting coexisting autoimmune diseases and adjusting the treatment in accordance with the chronic evolution of the disease.

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Quality-by-Design Enabled Chitosan Nanoparticles for Antitubercular Therapy: Formulation, Statistical Optimization, and In vitro Characterization

Current Drug Therapy ◽

10.2174/1574885515666200722150305 ◽

2020 ◽

Vol 15 ◽

Author(s):

Manasi M. Chogale ◽

Sujay S. Gaikwad ◽

Savita P. Kulkarni ◽

Vandana B. Patravale

Keyword(s):

Side Effects ◽

Treatment Regimen ◽

Research Work ◽

Chitosan Nanoparticles ◽

In Vitro Release ◽

Antitubercular Therapy ◽

Prolonged Treatment ◽

High Dose ◽

Average Size

Background: Tuberculosis (TB) continues to be among the leading causes for high mortality among developing countries. Though a seemingly effective treatment regimen against TB is in place, there has been no significant improvement in the therapeutic rates. This is primarily owing to the high drug doses, their associated sideeffects, and prolonged treatment regimen. Discontinuation of therapy due to the severe side effects of the drugs results in the progression of the infection to the more severe drug-resistant TB. Objectives: Reformulation of the current existing anti TB drugs into more efficient dosage forms could be an ideal way out. Nanoformulations have been known to mitigate the side effects of toxic, high-dose drugs. Hence, the current research work involves the formulation of Isoniazid (INH; a first-line anti TB molecule) loaded chitosan nanoparticles for pulmonary administration. Methods: INH loaded chitosan nanoparticles were prepared by ionic gelation method using an anionic crosslinker. Drugexcipient compatibility was evaluated using DSC and FT-IR. The formulation was optimized on the principles of Qualityby-Design using a full factorial design. Results: The obtained nanoparticles were spherical in shape having an average size of 620±10.97 nm and zeta potential +16.87±0.79 mV. Solid state characterization revealed partial encapsulation and amorphization of INH into the nanoparticulate system. In vitro release study confirmed an extended release of INH from the system. In vitro cell line based safety and efficacy studies revealed satisfactory results. Conclusion: The developed nanosystem is thus an efficient approach for antitubercular therapy.

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TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

Journal of Allergy ◽

10.1155/2013/130905 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 13

Author(s):

Freja Lærke Sand ◽

Simon Francis Thomsen

Keyword(s):

Side Effects ◽

Chronic Urticaria ◽

Treatment Options ◽

Significant Proportion ◽

Response Duration ◽

Immunosuppressive Drugs ◽

Tnf Alpha ◽

High Dose ◽

Duration Of Treatment ◽

Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

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Polyglandular Autoimmune Syndrome Triggered after CTLA-4 and PD-1L Immunotherapy Treatment

Reports ◽

10.3390/reports4010001 ◽

2021 ◽

Vol 4 (1) ◽

pp. 1

Author(s):

Juan Luis Fernández-Morera ◽

Alfredo Renilla González ◽

Carmen Elena Calvo Rodríguez ◽

Judit Romano-García

Keyword(s):

Immune Response ◽

Side Effects ◽

Autoimmune Diseases ◽

Autoimmune Diabetes ◽

Hashimoto Thyroiditis ◽

Polyglandular Autoimmune Syndrome ◽

Autoimmune Syndrome ◽

Previous Diagnosis ◽

Optimal Approach

Background: CTLA-4 and PD-1L are novel immune checkpoint targets for cancer treatment with specific side effects such as autoimmune diseases. Less frequently, the presence of several autoimmune diseases in the same patient has been described. In this communication, we illustrate the case of a 45-year-old patient with a previous diagnosis of advanced cancer that, after starting treatment with this immunotherapy, developed in the following months autoimmune diabetes, lymphocytic hypophysitis, and a Hashimoto thyroiditis in an abrupt and intense manner that would correspond to an autoimmune polyglandular disease. Discussion: The activation of autoimmunity and associated diseases is increasing in parallel with augmented indication of these immunotherapeutic treatments in cancer patients. A closer follow-up of these patients could be necessary for an optimal approach to this type of pathology. Conclusions: Different autoimmune diseases can converge in the same patient when immunotherapy for cancer is indicated to boost immune response against tumor, caused by altering immune tolerance.

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