Department of Dermatology, APHM, Hopital Timone, Aix-Marseille University, Marseille, France.
J Immunother. 2013 Jan;36(1):77-8. doi: 10.1097/CJI.0b013e31827807dd.
Ipilimumab is a fully human monoclonal antibody directed against cytotoxic T-lymphocyte antigen-4 recently approved for the treatment of metastatic melanoma and currently under investigation in the adjuvant setting of high-risk stage III melanoma. The blockade of CTLA-4 induces activation of T cells, with an expected increase in the immunological reaction directed to cancer. We report a case of ipilimumab-induced Guillain-Barré syndrome revealed by an occlusive enteric neuropathy. Two weeks after the second dose of ipilimumab, our patient started to complain of abdominal meteorism and nausea. Within a few days, an occlusive syndrome developed. Wall biopsies during colonoscopy revealed a slight edema of the mucosa and a high number of lymphocytic follicles, leading to the diagnosis of ipilimumab-induced immune colitis. A respiratory failure occurred and a neurological deficiency developed rapidly. The diagnosis of polyradiculoneuritis was retained. Despite IV steroids, tacrolimus than plasmatic exchanges, the patient died within a few days because of multivisceral failure. Polyradiculoneuritis is a rare but very severe immune-mediated complication of ipilimumab. Occlusive enteric neuropathy may mimic the digestive symptoms of colitis, which is so frequent under ipilimumab.
依匹单抗是一种针对细胞毒性 T 淋巴细胞相关抗原 4 的全人源单克隆抗体，最近被批准用于治疗转移性黑色素瘤，目前正在高危 III 期黑色素瘤的辅助治疗中进行研究。CTLA-4 的阻断诱导 T 细胞激活，预计会增加针对癌症的免疫反应。我们报告了一例依匹单抗引起的吉兰-巴雷综合征，表现为闭塞性肠神经病。依匹单抗第二剂治疗 2 周后，患者开始出现腹胀和恶心。几天后，出现闭塞综合征。结肠镜检查时的肠壁活检显示黏膜轻度水肿和大量淋巴细胞滤泡，导致诊断为依匹单抗引起的免疫性结肠炎。随后发生呼吸衰竭和迅速出现神经功能缺损。诊断为多神经根炎。尽管给予静脉内类固醇、他克莫司和血浆置换，但由于多器官功能衰竭，患者在几天内死亡。多神经根炎是依匹单抗罕见但非常严重的免疫介导的并发症。闭塞性肠神经病可能模拟结肠炎的消化症状，而结肠炎在依匹单抗治疗中非常常见。
