From the Department of Neurology (M.N., F.D.P., S.I., G.S.); Department of Dermatology and Venerology (N.H., V.A.N.); Department of Radiology (M.W.); and Department of Internal Medicine (J.G.), Medical University Innsbruck, Austria.
Neurol Neuroimmunol Neuroinflamm. 2020 May 27;7(4). doi: 10.1212/NXI.0000000000000773. Print 2020 Jul.
Immunotherapy revolutionized melanoma treatment; however, immune-related adverse events, especially neurotoxicity, may be severe and require early and correct diagnosis as well as early treatment commencement.
We report an unusual severe multiorgan manifestation of neurotoxicity after treatment with the anti-PDL1 immune checkpoint inhibitor, nivolumab, and the anticytotoxic T-lymphocyte-associated antigen 4 immune checkpoint inhibitor, ipilimumab, in a 47-year-old male patient with metastatic melanoma.
The patient developed immune-mediated synovitis and cranial neuritis, followed by longitudinal transverse myelitis, encephalitis, and optic neuritis. Early treatment with high-dose steroids and maintenance therapy with rituximab resulted in a favorable neurologic outcome.
The frequency of spinal cord involvement and neuronal toxicity after cancer immunotherapy is very low and requires an extensive diagnostic workup to differentiate between disease progression and side effects. Immune checkpoint inhibitors should be discontinued and treatment with corticosteroids should be initiated early as the drug of first choice. Therapy may be escalated by other immune-modulating treatments, such as rituximab.
免疫疗法彻底改变了黑色素瘤的治疗方法；然而，免疫相关的不良反应，尤其是神经毒性，可能很严重，需要早期正确诊断和及时开始治疗。
我们报告了一例 47 岁男性转移性黑色素瘤患者在使用抗 PD-1 免疫检查点抑制剂纳武单抗和抗细胞毒性 T 淋巴细胞相关抗原 4 免疫检查点抑制剂伊匹单抗治疗后出现的罕见严重多器官神经毒性表现。
该患者发生免疫介导性滑膜炎和颅神经炎，继而发生长节段横贯性脊髓炎、脑炎和视神经炎。早期采用大剂量类固醇治疗和利妥昔单抗维持治疗，获得了良好的神经结局。
癌症免疫治疗后脊髓受累和神经元毒性的频率非常低，需要进行广泛的诊断性检查，以区分疾病进展和药物副作用。应停用免疫检查点抑制剂，并尽早开始皮质类固醇治疗，作为首选药物。可通过其他免疫调节治疗（如利妥昔单抗）来升级治疗。
