SHM Converge Scientific Abstract ePoster Gallery-A New Sepsis Mimic: Recognizing Cytokine Release Syndrome in the Era of Immune Effector Therapies

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This case highlights cytokine release syndrome (CRS), a serious inflammatory reaction that can closely mimic sepsis in patients receiving immune-based cancer therapies. A 72-year-old man with extensive-stage small cell lung cancer was observed after his first infusion of tarlatamab-dlle (Imdelltra), a bispecific T-cell engager targeting DLL3. He was initially stable and discharged after 24 hours, but returned within another 24 hours with weakness, fever, chills, increased oxygen needs, hypotension, tachycardia, confusion, leukocytosis, hyponatremia, and elevated lactate. Infectious workup was negative, but he was initially treated as septic with fluids and broad-spectrum antibiotics.<br /><br />When his recent immunotherapy was recognized, clinicians suspected CRS. He received tocilizumab and dexamethasone with rapid improvement in blood pressure and mental status. Cultures remained negative, supporting CRS rather than infection.<br /><br />The report emphasizes that CRS is increasingly seen with modern immune effector therapies such as CAR-T cells, bispecific antibodies, and immune checkpoint inhibitors. With tarlatamab, CRS is relatively common and usually occurs soon after infusion, but this case shows it can present after standard observation windows and be mistaken for sepsis. CRS is graded using ASTCT criteria, which help guide treatment. Although the patient met Grade 2 CRS, his rapid decline justified early immunomodulatory therapy.<br /><br />The key message is that hospitalists should keep CRS in mind whenever a patient with recent immunotherapy presents with a sepsis-like syndrome. Early recognition and prompt treatment with agents such as tocilizumab and corticosteroids can prevent organ failure, improve outcomes, and reduce unnecessary antibiotic use.

Asset Subtitle

Andikan E. Udoh

Meta Tag

Author List Andikan E. Udoh, Renu Bhargavi Boyapati

Category Clinical Vignettes

Concept Cytokine Release Syndrome

Concept Systemic Inflammatory Response Syndrome

Concept Multiorgan Dysfunction

Concept Immune Effector Therapy

Concept Bispecific T-cell Engager

Distinguished Non-Finalist

Presenter Organization Baton Rouge General Medical Center

Presenting Author Andikan E. Udoh

Track Adult

Keywords

cytokine release syndrome

CRS

tarlatamab-dlle

Imdelltra

small cell lung cancer

bispecific T-cell engager

sepsis mimic

tocilizumab

dexamethasone

immunotherapy

Cytokine Release Syndrome

Systemic Inflammatory Response Syndrome

Multiorgan Dysfunction

Immune Effector Therapy

Bispecific T-cell Engager