一名 40 多岁的脾血管肉瘤转移至肝脏的患者在接受 CTLA4 和 PD1 抑制剂的临床试验之前接受了脾切除、化疗和部分肝切除术。脾切除后，他接受了肺炎球菌和脑膜炎球菌疫苗。第 10 周，他出现了 3 级免疫相关性结肠炎，并用抗肿瘤坏死因子-α 抑制剂英夫利昔单抗和类固醇成功治疗。 4个周期的治疗后，扫描显示部分缓解。他恢复了抗PD1治疗，第二剂抗PD1治疗后6小时，他因吐血、便血、低血压、发烧和血氧饱和度下降而被送往急诊室。实验室检查显示急性肾功能衰竭和败血症（肺炎链球菌）。在注射抗 PD1 药物 12 小时后，他因严重的脾切除后感染 (OPSI) 死亡。除其他发现外，尸检还显示出无法存活的肝脏肿瘤。总之，接受免疫治疗且有无脾病史的患者应密切监测 OPSI，因为他们的风险可能增加。版权所有 © 2024 Torrado、Baysal、Chakraborty、Norris、Khawaja 和 Tsimberidou。

A patient in his 40s with splenic angiosarcoma metastatic to the liver underwent splenectomy, chemotherapy, and partial hepatectomy before being treated on a clinical trial with CTLA4 and PD1 inhibitors. He had received pneumococcal and meningococcal vaccines post-splenectomy. On week 10, he developed grade 3 immune-related colitis, successfully treated with the anti-tumor necrosis factor-alpha inhibitor infliximab and steroids. After 4 cycles of treatment, scans showed partial response. He resumed anti-PD1 therapy, and 6 hours after the second dose of anti-PD1 he presented to the emergency room with hematemesis, hematochezia, hypotension, fever, and oxygen desaturation. Laboratory tests demonstrated acute renal failure and septicemia (Streptococcus pneumoniae). He died 12 hours after the anti-PD1 infusion from overwhelming post-splenectomy infection (OPSI). Autopsy demonstrated non-viable liver tumors among other findings. In conclusion, patients undergoing immunotherapy and with prior history of asplenia should be monitored closely for OPSI as they may be at increased risk.Copyright © 2024 Torrado, Baysal, Chakraborty, Norris, Khawaja and Tsimberidou.