Inflammatory demyelinating polyneuropathy versus leptomeningeal disease following Ipilimumab

Autor: Lorraine Cafuir, Alfredo Voloschin, Nilesh K. Desai, David H. Lawson, Vita Kesner
Rok vydání: 2017
Předmět:
Adult
Male
Cancer Research
Pathology
medicine.medical_specialty
Nerve root
Immunology
Ipilimumab
Case Report
lcsh:RC254-282
Diagnosis
Differential
03 medical and health sciences
Polyneuropathies
0302 clinical medicine
Cerebrospinal fluid
Antineoplastic Agents
Immunological
medicine
Meningeal Neoplasms
Inflammatory demyelinating polyneuropathy
Immunology and Allergy
Humans
Leptomeningeal carcinomatosis
Melanoma
Pharmacology
medicine.diagnostic_test
business.industry
Polyradiculoneuropathy
Paraneoplastic autoimmune disease
medicine.disease
Spinal cord
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.anatomical_structure
Oncology
030220 oncology & carcinogenesis
Nerve conduction study
Molecular Medicine
Immunotherapy
Complication
business
030217 neurology & neurosurgery
medicine.drug
Demyelinating Diseases
Autoimmune
Zdroj: Journal for Immunotherapy of Cancer
Journal for ImmunoTherapy of Cancer, Vol 6, Iss 1, Pp 1-5 (2018)
ISSN: 2051-1426
Popis: Background Ipilimumab is an FDA-approved anti-CTLA-4 monoclonal antibody used in treatment of metastatic melanoma. We present an unusual neurological complication of Ipilimumab therapy and the diagnostic dilemma it caused. Case presentation A 42 year old male with Stage IV metastatic melanoma developed lower extremity weakness and sensory neuropathy following three doses of Ipilimumab. MRI of the lumbar spine was initially interpreted as diffuse leptomeningeal disease, and patient began Dexamethasone and radiation with improvement in symptoms. However, subsequent completion imaging revealed smooth nerve root involvement with sparing of the spinal cord, findings more compatible with inflammatory demyelinating polyneuropathy. The absence of malignant cells in the cerebrospinal fluid (CSF) and nerve conduction study (NCS) showing lumbar polyradiculoneuropathy with axonal involvement and demyelinating features supported the diagnosis of inflammatory demyelinating polyneuropathy. Later in the course of his disease, the patient developed frank leptomeningeal melanoma. Conclusion Ipilimumab immune-related toxicity presented as inflammatory demyelinating polyneuropathy, which was difficult to distinguish from leptomeningeal disease, a common complication of melanoma.
Databáze: OpenAIRE
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