Khosravi Sepehr, Khoeini Tara, Rahattalab Fateme, Ashtiani Bahram Haghi
Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Case Rep Neurol. 2025 Jun 19;17(1):94-101. doi: 10.1159/000547004. eCollection 2025 Jan-Dec.
This case series highlights the various clinical manifestations of pembrolizumab-induced neurological adverse events, offering insights into the spectrum of immune-related neurological adverse events associated with immune checkpoint inhibitor (ICI) therapy.
We present 5 patients who received pembrolizumab as a part of their treatment. They exhibited a variety of clinical manifestations, which included central nervous system involvement and necrotizing myopathy, each responding differently to therapeutic interventions. Among the participants, there were two cases of myopathy, one case of demyelinating polyneuropathy, one individual whose myasthenia gravis had worsened, and 1 patient diagnosed with encephalitis. The patients experienced symptoms with varying degrees of severity, leading to different responses in their clinical treatment, and 1 patient ultimately passed away due to complications.
Neurological immune-related adverse effects (n-irAEs) are rare, and their identification poses a challenge due to their complexity and the presence of underlying autoimmune and paraneoplastic disorders. The expected prognosis for n-irAEs is unclear, presenting a range of complete recovery rates and differing mortality outcomes. The increased frequency of ICI usage increases the probability of an immune response, necessitating healthcare professionals to identify new symptoms in immunotherapy patients. Side effects differ from conventional chemotherapy and necessitate different therapeutic approaches.
本病例系列突出了帕博利珠单抗所致神经不良事件的各种临床表现，为了解与免疫检查点抑制剂（ICI）治疗相关的免疫相关性神经不良事件谱提供了见解。
我们介绍了5例接受帕博利珠单抗治疗的患者。他们表现出多种临床表现，包括中枢神经系统受累和坏死性肌病，对治疗干预的反应各不相同。参与者中，有2例肌病、1例脱髓鞘性多发性神经病、1例重症肌无力病情加重以及1例被诊断为脑炎的患者。患者经历了不同严重程度的症状，导致临床治疗反应各异，1例患者最终因并发症死亡。
神经免疫相关性不良反应（n-irAEs）较为罕见，由于其复杂性以及潜在自身免疫性和副肿瘤性疾病的存在，其识别具有挑战性。n-irAEs的预期预后尚不清楚，呈现出不同的完全恢复率和死亡率结果。ICI使用频率的增加提高了免疫反应的可能性，这就要求医护人员识别免疫治疗患者的新症状。其副作用与传统化疗不同，需要不同的治疗方法。
