Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Neurology, University of Colorado, Aurora, CO, United States of America; Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada.
Department of Neurology, University of Colorado, Aurora, CO, United States of America; Department of Neurosurgery, University of Colorado, Aurora, CO, United States of America.
J Neuroimmunol. 2020 Jul 15;344:577259. doi: 10.1016/j.jneuroim.2020.577259. Epub 2020 May 7.
Immune checkpoint inhibitors (ICIs) represent a major development in cancer treatment, allowing for improved survival and disease control in an expanding number of cancer types. Due to their mechanism of disrupting immunologic homeostasis, ICIs are frequently associated with adverse effects, termed immune related adverse effects (irAE). These side effects can affect any organ system, including the central and peripheral nervous systems. We present a case of a 47 year old man with stage IIIc metastatic melanoma who received 3 cycles of nivolumab (a monoclonal antibody inhibitor of programmed cell death protein 1 (PD-1)). After completing the third cycle, he presented with a meningoencephalitis clinical picture with an inflammatory cerebrospinal fluid (CSF) and normal MRI. He was found to have a positive anti-glial fibrillary acidic protein (GFAP) autoantibody in his CSF by immunofluorescent assay (IFA) and cell based assay (CBA) which confirmed a diagnosis of anti-GFAP autoimmune encephalitis. He was treated with immunotherapy and made a full recovery. In this report, we present the first reported case of anti-GFAP autoimmune encephalitis associated with ICI therapy and provide a brief review of the literature.
免疫检查点抑制剂 (ICIs) 代表了癌症治疗的重大进展，使得越来越多的癌症类型的患者的生存和疾病控制得到改善。由于其破坏免疫稳态的机制，ICI 经常与不良反应相关，称为免疫相关不良反应 (irAE)。这些副作用可以影响任何器官系统，包括中枢和外周神经系统。我们报告了 1 例 47 岁男性，患有 IIIc 期转移性黑色素瘤，接受了 3 个周期的纳武单抗（一种程序性死亡蛋白 1 (PD-1) 的单克隆抗体抑制剂）治疗。完成第 3 个周期后，他出现了脑膜脑炎的临床表现，伴有炎症性脑脊液 (CSF) 和正常的 MRI。他的 CSF 通过免疫荧光分析 (IFA) 和细胞基础分析 (CBA) 发现有阳性抗神经胶质纤维酸性蛋白 (GFAP) 自身抗体，从而确诊为抗 GFAP 自身免疫性脑炎。他接受了免疫治疗并完全康复。在本报告中，我们报告了首例与 ICI 治疗相关的抗 GFAP 自身免疫性脑炎病例，并简要回顾了文献。
