Ohno Narumi, Sugimoto Takamichi, Giga Mayumi, Naito Hiroyuki, Kono Tomoyuki, Nomura Eiichi
Department of Neurology, Hiroshima City Hiroshima Citizens Hospital.
Rinsho Shinkeigaku. 2021 Oct 28;61(10):658-662. doi: 10.5692/clinicalneurol.cn-001582. Epub 2021 Sep 25.
A 76-year-old man with renal cell carcinoma exhibited consciousness disturbance and high fever after two cycles of combination therapy with ipilimumab and nivolumab. His cerebrospinal fluid (CSF) showed a protein concentration of 385 mg/dl, a cell count of 147/mm, an interleukin-6 concentration of 1,280 pg/ml, and an adenosine deaminase concentration of 24.8 U/l. Contrast-enhanced FLAIR images were notable for diffuse meningeal enhancement. He was diagnosed with meningoencephalitis caused by an immune-related adverse event from immune checkpoint inhibitors (ICIs). His symptoms improved after repeated intravenous methylprednisolone pulse therapy and oral prednisolone. The meningeal enhancement disappeared, and the CSF findings became almost normal. As consciousness levels improved, we observed quadriplegia and peripheral neuropathy with antiganglioside antibodies, which led to a diagnosis of polyradiculoneuropathy. This is a rare case of a patient with overlapping meningoencephalitis and polyradiculo-neuropathy induced by ICIs.
一名76岁的肾细胞癌男性患者在接受两个周期的伊匹单抗和纳武单抗联合治疗后出现意识障碍和高热。他的脑脊液（CSF）显示蛋白浓度为385mg/dl，细胞计数为147/mm，白细胞介素-6浓度为1280pg/ml，腺苷脱氨酶浓度为24.8U/l。对比增强FLAIR图像显示弥漫性脑膜强化。他被诊断为由免疫检查点抑制剂（ICI）引起的免疫相关不良事件导致的脑膜脑炎。在反复静脉注射甲基强的松龙脉冲疗法和口服强的松龙后，他的症状有所改善。脑膜强化消失，脑脊液检查结果几乎恢复正常。随着意识水平的改善，我们观察到四肢瘫痪和伴有抗神经节苷脂抗体的周围神经病变，这导致了多神经根神经病的诊断。这是一例罕见的由ICI引起的重叠性脑膜脑炎和多神经根神经病患者。
