Case Studies

 Case 5.4 IL-2 treatment and rheumatoid arthritis

A 53-year-old man presented to his GP with pain in the right loin and intermittent haematuria. His only medical history was of mild rheumatoid arthritis which had presented at the age of 42 but which was currently in remission without any additional medication.

Examination revealed a large mass apparently arising from the right kidney. Subsequent investigation by a urologist demonstrated a large tumour replacing most of the right kidney but with no evidence of distant metastasis. He underwent a right nephrectomy. Histological examination confirmed that the tumour was a renal cell carcinoma.

He remained well for the next 2 years but then developed severe back pain. Further radiological studies demonstrated widespread metastases in bone, liver and lungs. He underwent treatment with recombinant human IL-2 as part of a clinical trial of combined chemotherapy and immunotherapy. Ten days after receiving IL-2, he developed a severe flare of his rheumatoid arthritis, necessitating treatment with corticosteroids. No further IL-2 was administered and his arthritis settled. His disseminated malignant disease did not respond to chemotherapy and he died 8 weeks later in his local hospice.