Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

A Rare Case of Autoimmune Encephalitis in a Patient After Treatment of Metastatic Melanoma with a Combination of Immune Checkpoint Inhibitors Nivolumab and Ipilimumab
Autoimmune Neurology
P10 - Poster Session 10 (5:30 PM-6:30 PM)
15-001
We report a severe clinical case of a patient with autoimmune encephalitis attributed to immune checkpoint inhibitors nivolumab and ipilimumab. Our objective is to report clinical features and highlight the importance of considering the above immune inhibitors as a cause of encephalopathy.
A 76 year old male was diagnosed with malignant melanoma and treated with ipilimumab and nivolumab, presenting with four days of worsening confusion, bizarre behavior, aggression, and hallucinations. MRI brain showed chronic microvascular changes and mild diffuse volume loss, and MRA head showed no evidence of vasculitis or occlusion. Lumbar puncture showed protein 77, glucose 48, RBC 1, and WBC 18 (92% lymphs). CSF studies were negative for infections. Serum and CSF autoimmune encephalopathy studies were negative. cEEG showed FIRDA and moderate diffuse slowing but no seizure or epileptiform discharges. He was started on empiric treatment with IV methylprednisolone with considerable improvement within a few days. He was discharged on a slow prednisone taper. Immunotherapy treatment was not resumed. About 3 months later, he was readmitted, and repeat workup was unrevealing. Steroid dose was increased to methylprednisolone 80 mg daily, and he had complete resolution of symptoms within one week.
NA
NA
The neurotoxicity of nivolumab and other PD1 inhibitors is rare and is largely defined by case reports. Here we present a case of autoimmune encephalitis, which is one such example that has been rarely reported in literature. Early recognition and treatment of these toxicities is essential for optimizing clinical outcomes in cancer patients. Clinical and historical features that may be useful in distinguishing autoimmune encephalopathy secondary to immune checkpoint inhibition from other types of encephalopathies include elevated CSF white blood cell count and protein, lack of fever, normal brain MRI, and exclusion of infectious and other inflammatory etiologies.
Authors/Disclosures
Ramya Tadipatri, MD (Banner Health)
PRESENTER 		Dr. Tadipatri has nothing to disclose.
Fawaz Philip Tarzi, MD (Barrow Neurological Inst) Dr. Tarzi has nothing to disclose.