Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2022 Mar 25;13:850540. doi: 10.3389/fimmu.2022.850540. eCollection 2022.
Toripalimab (Junshi Bioscience Co., Ltd) is a new immune checkpoint inhibitor (ICI) that targets programmed cell death protein 1 (PD-1) in various cancers, including metastatic melanoma. No neurological immune-related adverse events (n-irAEs) of toripalimab have been reported, except for neuromuscular involvement. We report a case of a 63-year-old woman who presented with severe vertigo, vomiting, nystagmus, cerebellar ataxia, and cognitive impairment after toripalimab treatment for metastatic melanoma. Compared with the concomitant cognitive dysfunction and a pathological reflex involving the cerebral cortex, the signs and symptoms of cerebellar involvement were much more prominent. Anti-glutamic acid decarboxylase 65 (anti-GAD65) antibody was positive in both serum and cerebrospinal fluid (CSF). After intravenous immunoglobulin (IVIG) and methylprednisolone (IVMP) administration, the symptoms of vertigo and vomiting resolved, with cognitive impairment and cerebellar ataxia remaining. This is the first report of autoimmune encephalitis (AIE) as an n-irAE of toripalimab.
特瑞普利单抗（君实生物）是一种新型的免疫检查点抑制剂（ICI），可靶向多种癌症中的程序性死亡蛋白 1（PD-1），包括转移性黑色素瘤。除了神经肌肉受累外，尚未报道特瑞普利单抗的神经免疫相关不良事件（n-irAEs）。我们报告了一例 63 岁女性病例，在转移性黑色素瘤接受特瑞普利单抗治疗后出现严重眩晕、呕吐、眼球震颤、小脑共济失调和认知障碍。与同时存在的认知功能障碍和涉及大脑皮层的病理反射相比，小脑受累的体征和症状更为明显。血清和脑脊液（CSF）中均检测到抗谷氨酸脱羧酶 65（anti-GAD65）抗体阳性。静脉注射免疫球蛋白（IVIG）和甲基强的松龙（IVMP）治疗后，眩晕和呕吐症状缓解，认知障碍和小脑共济失调仍存在。这是特瑞普利单抗引起的自身免疫性脑炎（AIE）作为 n-irAE 的首例报告。
