Nader Rita, Tannoury Esther, Rizk Tamina, Ghanem Hady
Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon.
Autops Case Rep. 2021 Apr 15;11:e2021261. doi: 10.4322/acr.2021.261.
Immune-mediated encephalitis as an adverse event due to checkpoint inhibitors is very rare. We describe herein the case of a 38-year-old woman with metastatic triple-negative breast cancer who developed seizures and somnolence twelve days after receiving the first dose of Atezolizumab. Work up ruled out all infectious etiologies, and the patient was eventually diagnosed with immune-mediated meningoencephalitis. Symptoms recovered with a high-dose of steroids, and she was found to have an excellent response on follow-up imaging, which raised the question of whether a relationship exists between the occurrence, and severity of the adverse event and the response to treatment. Only a few other cases of atezolizumab-related encephalitis have been published. Early recognition and treatment are crucial; the reason why we are describing this case along with a review of the literature and a review on all the neurological immune-related adverse events due to the different checkpoint inhibitors.
免疫介导性脑炎作为一种由检查点抑制剂引起的不良事件非常罕见。我们在此描述一例38岁转移性三阴性乳腺癌女性患者，在接受第一剂阿替利珠单抗12天后出现癫痫发作和嗜睡。检查排除了所有感染性病因，该患者最终被诊断为免疫介导性脑膜脑炎。症状通过大剂量类固醇治疗得以恢复，且在后续影像学检查中发现她反应良好，这就引发了一个问题，即不良事件的发生、严重程度与治疗反应之间是否存在关联。仅有其他几例与阿替利珠单抗相关的脑炎病例被报道过。早期识别和治疗至关重要；这就是我们为何要结合文献综述以及对不同检查点抑制剂所致所有神经免疫相关不良事件的综述来描述此病例的原因。
