case_images: PMC11109375_01
case_images: (A) Hematoxylin and eosin pathology slides from initial splenectomy. The fusocellular morphology, irregular nuclear atypia with enlarged nuclei, and spindle cell areas are indicative of splenic angiosarcoma with epithelioid features. (i) at 6x magnification and (ii) at 14x magnification. (B) CT scans indicating a partial response to immunotherapy. Images (i) to (iii) depict baseline CT scans before the initiation of anti-CTLA4 and anti-PDL1 therapy. Images (iv) to (vi) show partial response to treatment on restaging CT scans after 4 cycles. (C) Clinical course timeline of the case. Part i. encompasses the initial diagnosis involving splenectomy, followed by vaccination and adjuvant therapy. Part ii. delineates the three successive lines of metastatic therapy. Part iii. details the treatment of grade 3 immune-related diarrhea, its management with infliximab and steroids, the resumption of anti-PD1 therapy, and the subsequent fatal OPSI. 
  Figure 1C
   (i. ii. iii) was created with .
case_images: fimmu-15-1366271-g001.jpg
case_images: PMC11109375_04_fimmu-15-1366271-g001.jpg
case_images: f1
case_images: CT scans revealed a partial response (RECIST, decrease in tumor measurements by 44%) ( Figure 1B ), and he started cycle 5 of treatment with the PD-1 inhibitor in the outpatient setting. Blood cultures at autopsy confirmed the presence of Streptococcus pneumoniae ( Figure 1C ).
case_images: PMC11109375_02
case_images: PMC11109375_03
case_images: PMC11109375_04
case_images: (A) Hematoxylin and eosin pathology slides from initial splenectomy. The fusocellular morphology, irregular nuclear atypia with enlarged nuclei, and spindle cell areas are indicative of splenic angiosarcoma with epithelioid features. (i) at 6x magnification and (ii) at 14x magnification. (B) CT scans indicating a partial response to immunotherapy. Images (i) to (iii) depict baseline CT scans before the initiation of anti-CTLA4 and anti-PDL1 therapy. Images (iv) to (vi) show partial response to treatment on restaging CT scans after 4 cycles. (C) Clinical course timeline of the case. Part i. encompasses the initial diagnosis involving splenectomy, followed by vaccination and adjuvant therapy. Part ii. delineates the three successive lines of metastatic therapy. Part iii. details the treatment of grade 3 immune-related diarrhea, its management with infliximab and steroids, the resumption of anti-PD1 therapy, and the subsequent fatal OPSI. 
  Figure 1C
   (i. ii. iii) was created with .
case_images: fimmu-15-1366271-g001.jpg
case_images: PMC11109375_04_fimmu-15-1366271-g001.jpg
case_images: f1
case_images: CT scans revealed a partial response (RECIST, decrease in tumor measurements by 44%) ( Figure 1B ), and he started cycle 5 of treatment with the PD-1 inhibitor in the outpatient setting. Blood cultures at autopsy confirmed the presence of Streptococcus pneumoniae ( Figure 1C ).