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Severe thrombocytopenia and excellent response following combined immune checkpoint inhibition for metastatic malignant melanoma

Ever since the FDA-approval of the combined immune checkpoint (ICP) inhibition with the programmed death 1 (PD-1) antibody Nivolumab and the cytotoxic T-lymphocyte antigen 4 (CTLA4) antibody Ipilimumab for the treatment of malignant melanoma, the range and our understanding of immune-related adverse events (irAE) keeps broadening. Algorithms for the management of common irAE events such as colitis or thyroiditis have been established. However, monitoring and treatment for less common adverse events (AE) can be challenging. We present the case of a 54-year-old male melanoma patient who developed severe thrombocytopenia (CTCAE grade 4) due to combined ICP inhibition and was successfully re-challenged with ICP monotherapy.