Immune-Related Adverse Events Organized by Body System

Vocabulary practice flashcards covering immune-related adverse events (irAEs), categorized by body system (dermatologic, endocrine, gastrointestinal/hepatic, and pulmonary), their presenting symptoms, and clinical interventions.

Immune-Related Adverse Events (irAEs)

Toxicities and adverse reactions resulting from immunotherapy, categorized by physiological body system such as dermatologic/cutaneous, endocrine/metabolic, gastrointestinal/hepatic, and pulmonary.

Dermatology / Cutaneous irAEs (Presenting Symptoms)

Clinical presentations of dermatologic toxicity including rash and vitiligo (which presents in melanoma/progression).

Dermatology / Cutaneous irAEs (Interventions)

Management steps that include considering a dermatology referral and performing a skin biopsy (skin bx) if clinically indicated.

Vitiligo (in irAEs)

A cutaneous immune-related presentation marked by loss of skin pigmentation, associated with melanoma presentation or progression.

Endocrine / Metabolic irAEs (Presenting Symptoms)

Systemic endocrine toxicities presenting as hypothyroidism, hypophysitis, laboratory alterations in TSH, T3, T4, and ACTH, significant fatigue, decreased ($\downarrow$) appetite, and somnolence.

Endocrine / Metabolic irAEs (Interventions)

Therapeutic strategies consisting of considering an endocrinology referral and initiating hormone replacement.

Hypophysitis

An endocrine immune-related adverse event involving inflammation of the pituitary gland, causing alterations in ACTH and TSH, marked fatigue, decreased appetite, and somnolence.

irAE Colitis (Presenting Symptoms)

Gastrointestinal adverse event characterized by abdominal pain with endoscopic evidence of inflammation and watery diarrhea with an increased ($\uparrow$) stool frequency.

irAE Colitis (Interventions)

Starting corticosteroid titration at $1\text{ to }2\,\text{mg/kg/day}$, considering holding immunotherapy, and providing supportive therapy.

Supportive Therapy for irAE Colitis

Non-immunosuppressive measures including hydration, nutrition, loperamide, and maintaining electrolytes ($K$, $Na$, and magnesium).

irAE Liver Dysfunction / Hepatitis (Presenting Symptoms)

Hepatic toxicity manifesting as hepatitis and elevated liver enzyme levels, specifically elevated AST, ALT, and bilirubin.

irAE Liver Dysfunction / Hepatitis (Interventions)

Ruling out viral, drug, or disease-related causes via a hepatitis panel and abdominal ultrasound (US), holding immunotherapy for autoimmune hepatitis, and following liver lab trends.

Pulmonary irAEs (Presenting Symptoms)

Respiratory toxicities presenting with a persistent dry cough, shortness of breath, dyspnea on exertion, crackles, and a new $O_2$ requirement.

Pulmonary irAEs (Interventions)

Diagnostic and therapeutic actions including pulse oximetry (pulse ox), chest CT/workup, infectious disease (ID) and pulmonary consults, and considering corticosteroids.