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静脉注射甲泼尼龙治疗后，帕博利珠单抗相关神经病变伴下肢体感诱发电位改善

Pembrolizumab-associated Neuronopathy with Improved Lower Limb Somatosensory Evoked Potential After Intravenous Methylprednisolone Treatment.

作者信息

Tachiyama Keisuke, Naito Hiroyuki, Nakamori Masahiro, Aoki Shiro, Maruyama Hirofumi

机构信息

Department of Clinical Neuroscience and Therapeutics, Hiroshima University Hospital, Japan.

出版信息

Intern Med. 2025 May 1;64(9):1408-1411. doi: 10.2169/internalmedicine.4270-24. Epub 2024 Sep 18.

DOI:10.2169/internalmedicine.4270-24
PMID:39293979
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12120217/
Abstract

Cases of neuronopathy associated with immune checkpoint inhibitors (ICIs) have rarely been reported. We herein report a case of ICI-associated neuronopathy. A 54-year-old man underwent chemotherapy for right maxillary sinus cancer. Two months after pembrolizumab treatment, diarrhea, worsening of abnormal sensations, and severe ataxia of the lower limbs were observed. Somatosensory evoked potentials (SEPs) with tibial nerve stimulation showed disappearance of the N21 waveform. A colonic biopsy suggested ICI-associated colitis. Based on these findings, the patient was diagnosed with ICI-associated neuronopathy. Clinical symptoms and SEP findings improved markedly after two courses of intravenous methylprednisolone.

摘要

与免疫检查点抑制剂（ICI）相关的神经病变病例鲜有报道。我们在此报告一例ICI相关的神经病变。一名54岁男性因右上颌窦癌接受化疗。帕博利珠单抗治疗两个月后，出现腹泻、感觉异常加重及下肢严重共济失调。经胫神经刺激的体感诱发电位（SEP）显示N21波形消失。结肠活检提示为ICI相关的结肠炎。基于这些发现，该患者被诊断为ICI相关的神经病变。经过两个疗程的静脉注射甲泼尼龙后，临床症状和SEP结果明显改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8380/12120217/e1f5b24d839b/1349-7235-64-1408-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8380/12120217/13a45e16f7ec/1349-7235-64-1408-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8380/12120217/e1f5b24d839b/1349-7235-64-1408-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8380/12120217/13a45e16f7ec/1349-7235-64-1408-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8380/12120217/e1f5b24d839b/1349-7235-64-1408-g002.jpg

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本文引用的文献

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Selective immune suppression using interleukin-6 receptor inhibitors for management of immune-related adverse events.使用白细胞介素 6 受体抑制剂进行选择性免疫抑制治疗免疫相关不良事件。
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Neurology. 2019 Sep 10;93(11):e1093-e1103. doi: 10.1212/WNL.0000000000008091. Epub 2019 Aug 12.
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Immune checkpoint inhibitor-related myositis and myocarditis in patients with cancer.癌症患者的免疫检查点抑制剂相关肌炎和心肌炎。
Neurology. 2018 Sep 4;91(10):e985-e994. doi: 10.1212/WNL.0000000000006124. Epub 2018 Aug 8.
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