title: Multifocal radiculoneuropathy during ipilimumab treatment of melanoma.
abstract: BACKGROUND
  Ipilimumab, a monoclonal anti-CTLA-4 antibody, is used to treat melanoma. Neuromuscular side effects, possibly autoimmune, may occur.
  
  
  METHODS
  In this investigation we undertook a retrospective review of patient records.
  
  
  RESULTS
  After 3 doses of ipilimumab, a 31-year-old man developed asymmetric, severe weakness involving all limbs, respiration, and cranial nerves, which was progressive over 2 weeks. EMG/NCS showed an axonal polyradiculoneuropathy with multifocal motor conduction blocks. CSF protein was 749 mg/dl. Nerve pathology showed inflammation around the endoneurial microvessels and subperineurial edema and inflammation. Spine MRI showed leptomeningeal and anterior and posterior root enhancement. Strength improved slowly over months after ipilimumab discontinuation and immunomodulating treatment.
  
  
  CONCLUSIONS
  Ipilimumab toxicity presented as a monophasic, multifocal, asymmetric polyradiculoneuropathy involving roots and peripheral and cranial nerves. Ipilimumab may produce a polyradiculoneuropathy with disruption of the blood-nerve barrier due to a microvasculopathy.
authors: Department of Neurology Washington University School of Medicine, 600 South Euclid Avenue, St. Louis, Missouri, 63110, USA.
authors: Georgios
authors: G
authors: Manousakis
authors: James
authors: J
authors: Koch
authors: R Brian
authors: RB
authors: Sommerville
authors: Ahmed
authors: A
authors: El-Dokla
authors: Matthew B
authors: MB
authors: Harms
authors: Muhammad T
authors: MT
authors: Al-Lozi
authors: Robert E
authors: RE
authors: Schmidt
authors: Alan
authors: A
authors: Pestronk
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D003391:Cranial Nerves / Q000473:pathology; D004576:Electromyography; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D000074324:Ipilimumab; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D009431:Neural Conduction / Q000187:drug effects; D011129:Polyradiculoneuropathy / Q000139:chemically induced*; D011956:Receptors, Cell Surface / Q000378:metabolism; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013497:Sural Nerve / Q000473:pathology; D013997:Time Factors; D000098902:CD163 Antigen
chemical_list: D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D000098902:CD163 Antigen; D007155:Immunologic Factors; D000074324:Ipilimumab; D011956:Receptors, Cell Surface
keywords: immune neuropathy; ipilimumab; peripheral nervous system vasculitis; polyradiculopathy; toxic neuropathy