Marino Mark D, Mader John P, Kardasis William, Murphy Matthew, Mahmoud Shamseldeen Y
Radiology, Saint Louis University School of Medicine, Saint Louis, USA.
Cureus. 2025 May 19;17(5):e84407. doi: 10.7759/cureus.84407. eCollection 2025 May.
Immune effector cell-associated neurotoxicity syndrome (ICANS) is a potentially life-threatening complication often observed in patients receiving immunotherapies like chimeric antigen receptor T-cell (CAR-T) therapy. This case report is based on a chart review of the history, physical examination of the primary team, laboratory tests, imaging findings, and discharge summary of the patient's hospital admission and subsequent encounters. We present the case of a middle-aged man with multiple myeloma who developed ICANS following two cycles of talquetamab (Talvey) therapy. The patient's initial symptoms included fever and altered mental status. Magnetic resonance imaging (MRI) revealed a multitude of foci, including T1 enhancement of the hypothalamus and caudate heads, fluid-attenuated inversion recovery (FLAIR) hyperintensities of the caudate nuclei and subependymal regions, susceptibility artifacts in the lentiform nuclei, and diffusion restriction in the corpus callosum. Altered mental status, fever, and elevations in cerebrospinal protein raised concern for possible neurotoxicity, and the patient was treated with steroids and tocilizumab. A follow-up MRI taken 24 days later demonstrated a progression of signal abnormalities in the caudate nuclei and a new rim of susceptibility in the bilateral caudate heads. A third MRI was performed 99 days after the original MRI, which tracked the resolution of the diffusion restriction and FLAIR abnormalities, but noted further increased susceptibility artifacts and new peripherally enhancing lesions in the bilateral caudate heads. A final MRI taken 250 days after the initial MRI tracked the resolution of the caudate lesions, with stable susceptibility artifacts. This case highlights the evolving nature of ICANS and underscores the role of serial MRI in tracking neurotoxicity progression, guiding treatment, and improving outcomes in immunotherapy-related complications.
免疫效应细胞相关神经毒性综合征（ICANS）是一种潜在的危及生命的并发症，常见于接受嵌合抗原受体T细胞（CAR-T）疗法等免疫治疗的患者。本病例报告基于对患者住院及后续诊疗过程中的病史、主治团队的体格检查、实验室检查、影像学检查结果和出院小结的病历回顾。我们报告一例中年多发性骨髓瘤男性患者，在接受两个周期的他利妥单抗（Talvey）治疗后发生了ICANS。患者最初的症状包括发热和精神状态改变。磁共振成像（MRI）显示多个病灶，包括下丘脑和尾状核头部T1增强、尾状核和室管膜下区域的液体衰减反转恢复（FLAIR）高信号、豆状核的磁敏感伪影以及胼胝体的扩散受限。精神状态改变、发热和脑脊液蛋白升高引发了对可能神经毒性的担忧，患者接受了类固醇和托珠单抗治疗。24天后进行的随访MRI显示尾状核信号异常进展，双侧尾状核头部出现新的磁敏感环。在首次MRI检查99天后进行了第三次MRI检查，该检查追踪了扩散受限和FLAIR异常的消退情况，但发现磁敏感伪影进一步增加，双侧尾状核头部出现新的周边强化病灶。在首次MRI检查250天后进行的最后一次MRI检查追踪了尾状核病变的消退情况，磁敏感伪影稳定。本病例突出了ICANS的演变性质，并强调了系列MRI在追踪神经毒性进展、指导治疗以及改善免疫治疗相关并发症预后方面的作用。
