Immune checkpoint inhibitor-associated polyneuropathy in malignant pleural mesothelioma: A case report

JEM reports Pub Date : 2025-07-18 DOI:10.1016/j.jemrpt.2025.100184

Mehdi Kashani , Colleen Leu-Turner , Douglas E. Rappaport , James Kelley (Senior Author)

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Abstract

Background

Immune checkpoint inhibitors (ICIs), such as nivolumab and ipilimumab, have revolutionized treatment for malignant pleural mesothelioma (MPM) but may cause rare, immune-related neurological adverse events.

Case presentation

A 71-year-old man with recurrent MPM developed rapidly progressive weakness, sensory loss, and neuropathic pain following his second cycle of nivolumab/ipilimumab. Workup ultimately revealed inflammatory demyelinating and axonal polyradiculoneuropathy. Cerebrospinal fluid analysis supported an autoimmune process. High-dose corticosteroids and intravenous immunoglobulin (IVIG) were initiated, resulting in functional improvement. He was discharged on a steroid taper with outpatient follow-up.

Why should an emergency physician be aware of this?

This case highlights the importance of recognizing immune-mediated polyneuropathy as a potential complication of ICI therapy. Timely diagnosis, multidisciplinary care, and early immunosuppressive treatment can lead to meaningful recovery.

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恶性胸膜间皮瘤中免疫检查点抑制剂相关的多神经病变：1例报告

免疫检查点抑制剂（ICIs），如nivolumab和ipilimumab，已经彻底改变了恶性胸膜间皮瘤（MPM）的治疗，但可能导致罕见的免疫相关神经系统不良事件。病例介绍：一名71岁男性复发性MPM患者在第二次纳武单抗/伊匹单抗治疗后出现了快速进行性虚弱、感觉丧失和神经性疼痛。最终检查显示炎症性脱髓鞘和轴突性多根神经病变。脑脊液分析支持自身免疫过程。开始使用大剂量皮质类固醇和静脉注射免疫球蛋白（IVIG），导致功能改善。他出院后接受类固醇减量治疗，门诊随访。急诊医生为什么要意识到这一点？本病例强调了认识到免疫介导的多神经病变作为ICI治疗的潜在并发症的重要性。及时诊断、多学科护理和早期免疫抑制治疗可导致有意义的康复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JEM reports Emergency Medicine

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0.00%

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审稿时长

54 days