Department of Neurology Washington University School of Medicine, 600 South Euclid Avenue, St. Louis, Missouri, 63110, USA.
Muscle Nerve. 2013 Sep;48(3):440-4. doi: 10.1002/mus.23830. Epub 2013 Jul 27.
Ipilimumab, a monoclonal anti-CTLA-4 antibody, is used to treat melanoma. Neuromuscular side effects, possibly autoimmune, may occur.
In this investigation we undertook a retrospective review of patient records.
After 3 doses of ipilimumab, a 31-year-old man developed asymmetric, severe weakness involving all limbs, respiration, and cranial nerves, which was progressive over 2 weeks. EMG/NCS showed an axonal polyradiculoneuropathy with multifocal motor conduction blocks. CSF protein was 749 mg/dl. Nerve pathology showed inflammation around the endoneurial microvessels and subperineurial edema and inflammation. Spine MRI showed leptomeningeal and anterior and posterior root enhancement. Strength improved slowly over months after ipilimumab discontinuation and immunomodulating treatment.
Ipilimumab toxicity presented as a monophasic, multifocal, asymmetric polyradiculoneuropathy involving roots and peripheral and cranial nerves. Ipilimumab may produce a polyradiculoneuropathy with disruption of the blood-nerve barrier due to a microvasculopathy.
依匹单抗是一种单克隆抗 CTLA-4 抗体，用于治疗黑色素瘤。可能会发生神经肌肉副作用，这是一种自身免疫性疾病。
在这项研究中，我们对患者的病历进行了回顾性审查。
在接受 3 剂依匹单抗治疗后，一名 31 岁男性出现了不对称、严重的四肢无力、呼吸和颅神经无力，这种情况在 2 周内逐渐加重。肌电图/神经传导研究显示为多发性运动传导阻滞的轴索性多发性神经病。CSF 蛋白为 749mg/dl。神经病理学显示神经内膜微血管周围的炎症以及神经周围水肿和炎症。脊柱 MRI 显示软脑膜和前后根增强。在停用依匹单抗和免疫调节治疗后数月，肌力逐渐改善。
依匹单抗毒性表现为单相、多灶、不对称的多神经根神经病，累及根、周围和颅神经。依匹单抗可能会因微血管病导致血-神经屏障破坏而产生多神经根神经病。
