Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 151 No. 3536 (2021)

Bilateral proximal hamstring muscle avulsion after treatment with immune checkpoint inhibitors and corticosteroids

  • Nicolas Frei
  • Federico Caobelli
  • Diego Kyburz
DOI
https://doi.org/10.4414/SMW.2021.w30011
Cite this as:
Swiss Med Wkly. 2021;151:w30011
Published
08.09.2021

Abstract

A 66-year-old man presented with 4 weeks of bilateral buttock pain without previous trauma or intense exercise. He had been treated with immune checkpoint inhibitors because of metastasising melanoma and experienced immune-related adverse events requiring treatment with corticosteroids. Magnetic resonance imaging of the pelvis revealed bilateral avulsion of the proximal hamstring muscles. Treatment with physical therapy and nonsteroidal anti-inflammatory drugs led to a slow but lasting relief. This is, to our knowledge, the first report of symptomatic non-traumatic bilateral hamstring muscle avulsion following treatment with immune checkpoint inhibitors and corticosteroids.

References

  1. Cohen S, Bradley J. Acute proximal hamstring rupture. J Am Acad Orthop Surg. 2007 Jun;15(6):350–5. https://doi.org/10.5435/00124635-200706000-00004
  2. Startzman AN, Fowler O, Carreira D. Proximal Hamstring Tendinosis and Partial Ruptures. Orthopedics. 2017 Jul;40(4):e574–82. https://doi.org/10.3928/01477447-20170208-05
  3. Kwong Y, Patel J, Ramanathan EB. Spontaneous complete hamstring avulsion causing posterior thigh compartment syndrome. Br J Sports Med. 2006 Aug;40(8):723–4. https://doi.org/10.1136/bjsm.2005.022749
  4. Persson R, Jick S. Clinical implications of the association between fluoroquinolones and tendon rupture: the magnitude of the effect with and without corticosteroids. Br J Clin Pharmacol. 2019 May;85(5):949–59. https://doi.org/10.1111/bcp.13879
  5. Morales DR, Slattery J, Pacurariu A, Pinheiro L, McGettigan P, Kurz X. Relative and Absolute Risk of Tendon Rupture with Fluoroquinolone and Concomitant Fluoroquinolone/Corticosteroid Therapy: Population-Based Nested Case-Control Study. Clin Drug Investig. 2019 Feb;39(2):205–13. https://doi.org/10.1007/s40261-018-0729-y
  6. Khaliq Y, Zhanel GG. Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis. 2003 Jun;36(11):1404–10. https://doi.org/10.1086/375078
  7. Stephenson AL, Wu W, Cortes D, Rochon PA. Tendon Injury and Fluoroquinolone Use: A Systematic Review. Drug Saf. 2013 Sep;36(9):709–21. https://doi.org/10.1007/s40264-013-0089-8
  8. Cappelli LC, Gutierrez AK, Bingham CO 3rd, Shah AA. Rheumatic and musculoskeletal immune-related adverse events due to immune checkpoint inhibitors: A systematic review of the literature. Arthritis Care Res (Hoboken). 2017 Nov;69(11):1751–63. https://doi.org/10.1002/acr.23177
  9. Inamo J, Kaneko Y, Takeuchi T. Inflammatory tenosynovitis and enthesitis induced by immune checkpoint inhibitor treatment. Clin Rheumatol. 2018 Apr;37(4):1107–10. https://doi.org/10.1007/s10067-018-4035-0
  10. Roberts J, Ennis D, Hudson M, Ye C, Saltman A, Himmel M, et al. Rheumatic immune-related adverse events associated with cancer immunotherapy: A nationwide multi-center cohort. Autoimmun Rev. 2020 Aug;19(8):102595. https://doi.org/10.1016/j.autrev.2020.102595
  11. Daoussis D, Kraniotis P, Filippopoulou A, Argiriadi R, Theodoraki S, Makatsoris T, et al. An MRI study of immune checkpoint inhibitor-induced musculoskeletal manifestations myofasciitis is the prominent imaging finding. Rheumatology (Oxford). 2020 May;59(5):1041–50. https://doi.org/10.1093/rheumatology/kez361
  12. Thompson SM, Fung S, Wood DG. The prevalence of proximal hamstring pathology on MRI in the asymptomatic population. Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):108–11. https://doi.org/10.1007/s00167-016-4253-4

Most read articles by the same author(s)