免疫检查点抑制剂诱导的模拟韦尼克脑病的脑炎- 1例报告。

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY
Clinical Neurology and Neurosurgery Pub Date : 2025-10-01 Epub Date: 2025-08-07 DOI:10.1016/j.clineuro.2025.109091
Youjiang Tan, Wilson Shijie Chan, Xiaomin Mu
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引用次数: 0

摘要

免疫检查点抑制剂自2010年代初问世以来,已经彻底改变了许多癌症的治疗方法。因此,免疫检查点抑制剂诱导的脑炎(ICI-iE)在科学文献中越来越多地被报道,但由于其非特异性的临床放射学特征,其诊断可能具有挑战性。在此,我们报告一例老年男性转移性肾细胞癌患者,在接受派姆单抗治疗一年多后出现ICI-iE。然而,涉及双侧乳状体、内侧丘脑和导水管周围灰质的影像学异常与韦尼克脑病相似,导致误诊和治疗延误。此外,对ICI-iE的误诊和不恰当地保留派姆单抗的担忧进一步导致了延误,而派姆单抗在那时是有效和耐受性良好的。本病例说明了诊断ICI-iE的挑战,并强调了当接受免疫检查点抑制剂的患者出现神经认知缺陷时,高度怀疑的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Immune checkpoint inhibitor-induced encephalitis mimicking Wernicke encephalopathy - A case report.

Immune checkpoint inhibitors have revolutionized the treatment of many cancers since their introduction in the early 2010s. Consequently, immune checkpoint inhibitor-induced encephalitis (ICI-iE) is increasingly reported in scientific literature, but its diagnosis can be challenging due to the non-specific clinico-radiological features. Herein, we report the case of an elderly man with metastatic renal cell carcinoma, who developed ICI-iE slightly over a year into his pembrolizumab treatment. However, radiological abnormalities involving bilateral mamillary bodies, medial thalami, and the periaqueductal grey mimicked those seen in Wernicke encephalopathy, resulting in misdiagnosis and treatment delays. Furthermore, concerns over misdiagnosing ICI-iE and inappropriately withholding pembrolizumab, which up to that point had been effective and well-tolerated, further contributed to the delay. This case illustrates the challenges in diagnosing ICI-iE, and emphasizes the importance of a high index of suspicion when neurocognitive deficits develop in those receiving immune checkpoint inhibitors.

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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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