神经中间丝副肿瘤自身免疫合并 Merkel 细胞癌avelumab 治疗的并发症。
Neuronal intermediate filament paraneoplastic autoimmunity complicating avelumab therapy of Merkel cell carcinoma.
机构信息
Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
Departments of Laboratory Medicine and Pathology, Rochester, MN, USA; Neurology Mayo Clinic, Rochester, MN, USA.
出版信息
J Neuroimmunol. 2022 Jul 15;368:577882. doi: 10.1016/j.jneuroim.2022.577882. Epub 2022 May 5.
A 67-years-old woman developed subacute oculomotor nerve palsy and cerebellar gait instability while receiving avelumab as immunotherapy for Merkel cell carcinoma. Brain MRI revealed oculomotor nerve T2/FLAIR hyperintensity and contrast enhancement, CSF cell number and protein concentration were slightly increased. Antibodies against intracellular and surface antigens were excluded through commercial assays, but home-made immunohistochemistry on rat brain sections showed a "neurofilament-like" pattern. Antibodies against neuronal intermediate filament (NIF-IgG) were thus tested and resulted positive in both serum and CSF, confirming the diagnosis of NIF-IgG autoimmunity. Avelumab was discontinued and treatment with steroids and intravenous immunoglobulins led to partial improvement.
一位 67 岁女性在接受 Merkel 细胞癌的免疫治疗用avelumab 时，出现亚急性动眼神经麻痹和小脑步态不稳。脑部 MRI 显示动眼神经 T2/FLAIR 信号增高和对比增强，CSF 细胞数和蛋白浓度略有增加。通过商业检测排除了针对细胞内和细胞表面抗原的抗体，但在大鼠脑切片上进行的自制免疫组化显示出“神经丝样”模式。针对神经元中间丝（NIF-IgG）的抗体进行了检测，血清和 CSF 均为阳性，确诊为 NIF-IgG 自身免疫。停用 avelumab，并采用类固醇和静脉注射免疫球蛋白治疗，部分改善。
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