College of Medicine, Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
College of Medicine, Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA.
BMJ Case Rep. 2024 Feb 17;17(2):e258141. doi: 10.1136/bcr-2023-258141.
Nivolumab is a programmed death-1 receptor blocker within the family of medications called immune checkpoint inhibitors (ICIs). Although generally well tolerated, cases of immune-related adverse events (irAEs) have been reported. We present a case of a man being treated with nivolumab for renal cell carcinoma who presented to the emergency department with problems of headache, fever and disorientation. After extensive evaluation, a diagnosis of immunotherapy-induced aseptic meningitis was considered more probable than infectious. Due to stable clinical status, no treatment was initiated, and the patient's condition improved spontaneously. The patient was discharged home. To date, only a handful of prior cases of nivolumab-induced meningitis have been reported. Our case demonstrates that irAEs can occur years after the initiation of ICIs. This was a milder presentation of a neurological irAE that resolved spontaneously with watchful waiting, showing that irAEs are likely an evolving spectrum of disease for which clinicians should be aware.
纳武利尤单抗是一种程序性死亡受体-1 抑制剂，属于免疫检查点抑制剂（ICI）药物家族。尽管通常具有良好的耐受性，但已报告了免疫相关不良事件（irAE）的病例。我们报告了一例接受纳武利尤单抗治疗肾细胞癌的男性患者，他因头痛、发热和定向障碍到急诊科就诊。经过广泛评估，免疫治疗相关无菌性脑膜炎的诊断比感染更有可能。由于临床状况稳定，未进行任何治疗，患者病情自行改善。患者出院回家。迄今为止，仅报道了少数几例纳武利尤单抗引起的脑膜炎病例。我们的病例表明，irAE 可在 ICI 开始后数年发生。这是一种较轻的神经系统 irAE 表现，通过观察等待自发缓解，表明 irAE 可能是一种不断发展的疾病谱，临床医生应该对此有所了解。
