title: Late-onset paraplegia after complete response to two cycles of ipilimumab for metastatic melanoma.
abstract: BACKGROUND
  Ipilimumab has been shown to improve overall survival in patients with metastatic melanoma; however, complete responses (CRs) are uncommon. Immune-related side effects usually involve the skin or gastrointestinal tract. Neurologic events occur less frequently but are well described.
  
  
  METHODS
  We report the case of a 58-year-old man with metastatic melanoma who commenced ipilimumab post spinal decompression and radiation. He developed a colitis post cycle 2 and ipilimumab was discontinued. Imaging, however, documented a radiological CR. 8 weeks later, he developed paraplegia and a myelitis despite an ongoing radiological CR. Steroid use resulted in some improvement radiologically, without clinical improvement.
  
  
  CONCLUSIONS
  We report myelitis with consequent paraplegia as a potential neurological immune-related side effect of ipilimumab. We further describe a patient with a CR after 2 cycles of ipilimumab in the setting of radiation.
authors.affiliation: Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Grainne M
authors.initials: GM
authors.lastname: O'Kane
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Lyons
authors.forename: Gabrielle C
authors.initials: GC
authors.lastname: Colleran
authors.forename: Marzuki Wan
authors.initials: MW
authors.lastname: Ahmad
authors.forename: Scheryll
authors.initials: S
authors.lastname: Alken
authors.forename: Eoin C
authors.initials: EC
authors.lastname: Kavanagh
authors.forename: David
authors.initials: D
authors.lastname: Fitzpatrick
authors.forename: Brian
authors.initials: B
authors.lastname: Murray
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Kelly
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D003092:Colitis / Q000139:chemically induced / Q000175:diagnosis; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019788:Fluorodeoxyglucose F18; D006801:Humans; D000074324:Ipilimumab; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D064847:Multimodal Imaging; D009187:Myelitis / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D010264:Paraplegia / Q000139:chemically induced* / Q000175:diagnosis; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D000077204:Temozolomide; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D018906:Antineoplastic Agents, Alkylating; D000074324:Ipilimumab; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D003606:Dacarbazine; D000077204:Temozolomide