Case of the Month #57 A haematology patient with shock

CRS most often occurs within the first week following infusion of CAR-T cells, and the earliest signs and symptoms include fever, headache, myalgia, and gastrointestinal upset. A fever of more than 38.0°C is required for diagnosis.   

Other features include: 

• Respiratory failure, often with features of pulmonary oedema due to capillary leak 
• Cardiovascular toxicity including arrythmias and new-onset cardiomyopathy 
• Acute kidney injury 
• Skin rash 
• Vasodilatory shock 
• Electrolyte disturbance  

CRS severity can be graded according to the American Society for Transplantation and Cellular Therapy classification system⁷: