Immune Checkpoint Inhibitor-Related Dysautonomia in Merkel Cell Carcinoma: A Case Report

IF 1.9 Q4 ONCOLOGY

Cancer reports Pub Date : 2025-07-07 DOI:10.1002/cnr2.70274

Nidhi Kuchimanchi, Sai Gajula, Elizabeth M. Gaughan, Russell G. Witt

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Abstract

Background

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that block inhibitory pathways that cancer cells exploit to suppress T-cell activation. Although immune-related adverse events (irAEs) linked to ICI therapy are well documented and encompass dermatologic, endocrine, gastrointestinal, hepatic, and neurologic systems, ICI-related dysautonomia remains a rare phenomenon. Management of ICI-related dysautonomia is undefined.

Case

We report the case of a 57-year-old male patient treated with neoadjuvant nivolumab for Merkel cell carcinoma who developed ICI-related dysautonomia. His dysautonomia was characterized by orthostatic hypotension, urinary retention, hearing loss, and binocular diplopia in addition to the development of ICI-related hepatitis. We describe the patient's course, including the treatment and outcome of his dysautonomia, and review the literature on this rare toxicity.

Conclusion

Due to the mechanism of action of ICIs, irAEs can present with a wide range of manifestations. In this case, prompt recognition of ICI-induced dysautonomia and timely administration of intravenous immunoglobulin (IVIG) led to significant clinical improvement. ICI-induced dysautonomia is a rare condition that is difficult to diagnose and manage.

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默克尔细胞癌中免疫检查点抑制相关的自主神经异常1例报告

免疫检查点抑制剂（ICIs）是一种单克隆抗体，可以阻断癌细胞利用抑制t细胞激活的抑制途径。尽管与ICI治疗相关的免疫相关不良事件（irAEs）已被充分记录，包括皮肤、内分泌、胃肠、肝脏和神经系统，但ICI相关的自主神经异常仍然是一种罕见的现象。ici相关的自主神经异常的处理尚不明确。我们报告了一例57岁的男性患者，接受新辅助纳沃单抗治疗默克尔细胞癌，并发ici相关的自主神经异常。他的自主神经异常的特征是直立性低血压，尿潴留，听力下降，双眼复视，以及ici相关肝炎的发展。我们描述了患者的病程，包括治疗和他的自主神经异常的结果，并回顾了有关这种罕见毒性的文献。结论由于ICIs的作用机制，irAEs可以表现出广泛的表现。在这种情况下，及时识别ici引起的自主神经异常并及时静脉注射免疫球蛋白（IVIG）导致临床显著改善。ici诱导的自主神经异常是一种罕见的疾病，很难诊断和治疗。

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