Department of Respiratory Medicine, Kitakyushu General Hospital, Kitakyushu, Japan.
Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
Thorac Cancer. 2023 Jul;14(19):1899-1903. doi: 10.1111/1759-7714.14933. Epub 2023 May 30.
A 69-year-old Japanese male with advanced lung adenocarcinoma developed neurological symptoms after chemoradiotherapy and durvalumab maintenance therapy. He was positive for serum antiamphiphysin antibody, which is rarely seen in patients with lung adenocarcinoma. Additionally, his brain magnetic resonance images showed limbic encephalitis which led to the diagnosis of classic paraneoplastic neurological syndrome (PNS). Immune checkpoint inhibitors (ICIs) activate T cells and may also activate antineuronal antibodies that cause PNS. Durvalumab, which is an ICI, may have led to antiamphiphysin antibody-positive PNS in our patient. Treatment with systemic high-dose methylprednisolone was unsuccessful and he died 2 months later. PNS should be considered as one of the differential diagnoses in patients with lung cancer and neurological symptoms during, or after, ICI treatment.
一位 69 岁的日本男性，患有晚期肺腺癌，在接受放化疗和度伐鲁单抗维持治疗后出现神经症状。他的血清抗 Amphiphysin 抗体呈阳性，这种情况在肺腺癌患者中很少见。此外，他的脑部磁共振成像显示边缘性脑炎，这导致了经典的副肿瘤性神经系统综合征（PNS）的诊断。免疫检查点抑制剂（ICIs）激活 T 细胞，也可能激活导致 PNS 的抗神经元抗体。度伐鲁单抗是一种 ICI，可能导致我们的患者出现 Amphiphysin 抗体阳性的 PNS。全身大剂量甲基强的松龙治疗无效，他在 2 个月后死亡。在接受 ICI 治疗期间或之后出现肺癌和神经症状的患者，应将 PNS 视为鉴别诊断之一。
