Khimani Karima, Patel Sapna P, Whyte Andrew, Al-Zubidi Nagham
Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, United States.
Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Oncol. 2022 Mar 23;12:806501. doi: 10.3389/fonc.2022.806501. eCollection 2022.
The development of immune checkpoint inhibitors (ICIs) has greatly improved survival of patients with advanced malignancies. ICIs can cause immune-related adverse effects (irAEs) involving any organ. Neurological irAEs are infrequent and have mostly been reported in patients with melanoma. We describe the case of a 57-year-old male with right eye uveal melanoma, gene expression profile (class 2), and PRAME (preferentially expressed antigen in melanoma) positivity, who received plaque brachytherapy with Iodine-125 for 4 days with subsequent adjuvant ICIs (immune checkpoint inhibitors), nivolumab and ipilimumab. 18 weeks after discontinuation of immunotherapy, the patient presented with acute onset of left-sided headaches, pain with eye movements, and vision loss. The patient was tested positive for serum anti-aquaporin-4 antibody (AQP4-Ab) and was diagnosed with neuromyelitis optica spectrum disorder (NMOSD). Subsequently, he was treated with 5 days of intravenous methylprednisolone followed by an oral prednisone taper over 10 weeks, with improvement in symptoms. We report a unique case of neuromyelitis optica spectrum disorder (NMOSD) following treatment with ICIs. To our best knowledge, this is the third reported case in English literature of NMOSD following ICI therapy and the first reported case of NMOSD caused by ICI treatment in uveal melanoma.
免疫检查点抑制剂（ICI）的发展极大地提高了晚期恶性肿瘤患者的生存率。ICI可引起涉及任何器官的免疫相关不良反应（irAE）。神经系统irAE并不常见，主要在黑色素瘤患者中报道。我们描述了一名57岁男性患者的病例，该患者患有右眼葡萄膜黑色素瘤，基因表达谱为2类且PRAME（黑色素瘤中优先表达的抗原）呈阳性，接受了为期4天的碘-125斑块近距离放射治疗，随后接受辅助ICI（免疫检查点抑制剂）、纳武单抗和伊匹单抗治疗。免疫治疗停药18周后，患者出现急性左侧头痛、眼球运动疼痛和视力丧失。患者血清抗水通道蛋白4抗体（AQP4-Ab）检测呈阳性，被诊断为视神经脊髓炎谱系障碍（NMOSD）。随后，他接受了5天的静脉注射甲泼尼龙治疗，随后在10周内逐渐减量口服泼尼松，症状有所改善。我们报告了一例ICI治疗后发生视神经脊髓炎谱系障碍（NMOSD）的独特病例。据我们所知，这是英文文献中第三例报道的ICI治疗后发生NMOSD的病例，也是第一例报道的因ICI治疗葡萄膜黑色素瘤导致NMOSD的病例。
