Kawanaka Hiroki, Tajiri Kazuto, Muraishi Nozomu, Murayama Aiko, Nukui Takamasa, Yasuda Ichiro
Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
Department of Neurology, University of Toyama, Toyama, Japan.
Case Rep Gastroenterol. 2024 Jan 4;18(1):8-13. doi: 10.1159/000535476. eCollection 2024 Jan-Dec.
Immune checkpoint inhibitors are sometimes associated with immune-related adverse events during or after treatment. Among these, aseptic meningitis is a rare and serious complication. We report the first case of atezolizumab-induced aseptic meningitis, which occurred during treatment for advanced hepatocellular carcinoma (HCC).
A 74-year-old woman diagnosed with advanced HCC and treated with first-line atezolizumab plus bevacizumab developed anorexia, fatigue, and fever, after three treatment cycles. Cerebrospinal fluid examination showed slightly increased cell count and protein level but no infection or malignancy. Contrast enhancement along the cerebral sulcus was evident in contrast-enhanced magnetic resonance imaging, and the patient was diagnosed with aseptic meningitis associated with atezolizumab. Steroid therapy soon improved her clinical symptoms, and the contrast enhancement along the cerebral sulcus disappeared.
Clinicians should monitor to avoid serious immune-related adverse events, such as aseptic meningitis, in patients during treatment of HCC with immune checkpoint inhibitors and make the diagnosis as soon as possible.
免疫检查点抑制剂在治疗期间或治疗后有时会与免疫相关不良事件相关联。其中，无菌性脑膜炎是一种罕见且严重的并发症。我们报告了首例阿替利珠单抗诱导的无菌性脑膜炎病例，该病例发生在晚期肝细胞癌（HCC）治疗期间。
一名74岁女性被诊断为晚期HCC并接受一线阿替利珠单抗联合贝伐单抗治疗，在三个治疗周期后出现厌食、疲劳和发热。脑脊液检查显示细胞计数和蛋白水平略有升高，但未发现感染或恶性肿瘤。对比增强磁共振成像显示脑沟有明显的对比增强，患者被诊断为与阿替利珠单抗相关的无菌性脑膜炎。类固醇治疗很快改善了她的临床症状，脑沟的对比增强消失。
临床医生在使用免疫检查点抑制剂治疗HCC患者时应进行监测，以避免发生严重的免疫相关不良事件，如无菌性脑膜炎，并应尽快做出诊断。
