Immune Checkpoint Inhibitor Toxicity — Viva Defence

Candidate's opening statement (SASPOP)

"Thank you. I have reviewed Mr K, a 64-year-old retired engineer who presents to the emergency department with a three-week history of progressive bloody diarrhoea, a diffuse itchy rash, fatigue and dizziness on standing, three weeks into cycle 4 of combination ipilimumab and nivolumab for metastatic melanoma. His cardinal findings are postural hypotension, abdominal tenderness, a maculopapular rash over 25 per cent of his body surface area, and laboratory evidence of panhypopituitarism with secondary adrenal insufficiency, transaminitis, and acute kidney injury. My integrated diagnosis is multisystem grade 3 immune-related adverse event from his checkpoint inhibitors, with the adrenal crisis as the immediate life threat." ^[1]