Ipilimumab-induced encephalopathy with a reversible splenial lesion.
Ipilimumab, an anticytotoxic T-lymphocyte antigen (CTLA)-4 monoclonal antibody, is a first-line therapy for stage IV melanoma. Although high-grade immune-related adverse events occur in 25% of patients receiving ipilimumab, serious neurologic toxicity, primarily consisting of transient sensory and motor neuropathies, affects less than 1% of patients. We present a case report of a patient with melanoma who received high-dose ipilimumab at 10 mg/kg as first-line therapy for metastatic disease. After the third dose, the patient developed "mild" encephalopathy with a reversible splenial lesion (MERS) of the corpus callosum by MRI and neurogenic bladder, two novel immune-related adverse events during checkpoint inhibition. In addition to headache, delirium, and altered consciousness commonly seen with MERS, the patient also developed tremor, gait instability, paresthesias, and neurogenic bladder. The latter two symptoms were thought to represent sensory and autonomic neuropathies, respectively. The syndrome gradually resolved following intravenous methylprednisolone at 2 mg/kg divided twice daily for 5 days and a slow taper of oral prednisone over 8 weeks.
Division of Hematology Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. rconry@uabmc.edu.
Robert M
RM
Conry
Neuroradiology Section, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
Joseph C
JC
Sullivan
Neuro-Oncology Program, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
Louis B
LB
Nabors
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology*; D060908:CTLA-4 Antigen / Q000037:antagonists & inhibitors; D006801:Humans; D000074324:Ipilimumab; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000150:complications* / Q000188:drug therapy / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D013154:Spleen / Q000187:drug effects / Q000473:pathology*
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D060908:CTLA-4 Antigen; D000074324:Ipilimumab