Department of Internal Medicine, Lo-Sheng Sanatorium and Hospital Ministry of Health and Welfare, New Taipei, Taiwan; Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei City, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2023 Nov;122(11):1208-1212. doi: 10.1016/j.jfma.2023.07.019. Epub 2023 Aug 9.
We report the case of a 76-year-old man who was diagnosed with advanced stage hepatocellular carcinoma and was treated with atezolizumab plus bevacizumab therapy. Two weeks after 1st dose, he presented with acute changes in consciousness followed by hypothermia. A cerebrospinal fluid test showed an elevated cell count, total protein, and albumin. Infectious, anatomical, endocrinal, and neoplastic etiologies were ruled out. Based on the findings, atezolizumab-induced encephalitis was suspected, and high dose steroid therapy was administered. The patient's conscious level and hypothermia recovered completely about 9 days after starting the steroids, and he recovered without any neurological sequelae. This case report reminds physicians that prompt administration of steroid treatment after early diagnosis of immune checkpoint inhibitor-related encephalitis is the key for patients to recover without apparent neurological sequelae.
我们报告了一例 76 岁男性患者，被诊断为晚期肝细胞癌，并接受了阿替利珠单抗联合贝伐珠单抗治疗。在第 1 剂后两周，他出现了意识状态急性改变，随后出现了体温过低。脑脊液检查显示细胞计数、总蛋白和白蛋白升高。排除了感染性、解剖性、内分泌性和肿瘤性病因。根据这些发现，怀疑为阿替利珠单抗诱导的脑炎，并给予大剂量类固醇治疗。患者的意识水平和体温过低在开始使用类固醇后约 9 天完全恢复，他没有任何神经后遗症恢复。本病例报告提醒医生，在早期诊断免疫检查点抑制剂相关脑炎后，及时给予类固醇治疗是患者无明显神经后遗症恢复的关键。
