Treatment-refractory immune checkpoint inhibitor-induced hemophagocytic lymphohistiocytosis in the setting of adjuvant pembrolizumab for resected stage IIC melanoma: a case report

This case underscores the diagnostic complexities of hemophagocytic lymphohistiocytosis, the importance of a multidisciplinary approach to management, and the fatal side effects of extended immunosuppression. This also highlights the importance of the discussion of risks versus benefits of treatment, particularly in the adjuvant setting, emphasizing the rare but real risk of fatal toxicities. Prolonged immunosuppression can lead to severe complications, and judicious use of corticosteroids with intensive prophylaxis is crucial. Further research into the mechanism of checkpoint inhibitor-induced toxicities is critical in the era of immunotherapy to allow personalized immunosuppressive and steroid-sparing strategies in complex cases.