Nakatani Yuki, Tanaka Natsuki, Enami Tomomi, Minami Seigo, Okazaki Tomoko, Komuta Kiyoshi
Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
Department of Neurology, Osaka Police Hospital, Osaka, Japan.
Case Rep Neurol. 2018 Dec 5;10(3):346-352. doi: 10.1159/000494078. eCollection 2018 Sep-Dec.
Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia. Findings from a nerve conduction study and a positive anti-P/Q-type voltage-gated calcium channel antibody made a diagnosis of LEMS. Pyridostigmine and 3,4-diaminopyridine temporarily improved her symptoms. This was the first case of LEMS as a neurological irAE. LEMS should be considered as a possible neurological irAE.
兰伯特-伊顿肌无力综合征（LEMS）是一种典型的副肿瘤性神经综合征。近来，抗程序性细胞死亡蛋白1抑制剂纳武单抗已被批准用于治疗晚期非小细胞肺癌。应密切关注包括神经毒性在内的免疫相关不良事件（irAE）。我们在此报告一名73岁女性，在接受纳武单抗治疗肺鳞状细胞癌期间发生了LEMS。纳武单抗治疗第20周后，她出现了诸如睑下垂、下肢无力和畏光等各种神经症状。神经传导研究结果及抗P/Q型电压门控钙通道抗体阳性确诊为LEMS。吡啶斯的明和3,4-二氨基吡啶使她的症状暂时得到改善。这是首例LEMS作为神经免疫相关不良事件的病例。应将LEMS视为一种可能的神经免疫相关不良事件。
