Mehdi Kashani , Colleen Leu-Turner , Douglas E. Rappaport , James Kelley (Senior Author)
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Immune checkpoint inhibitor-associated polyneuropathy in malignant pleural mesothelioma: A case report
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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