title: Nivolumab-induced chronic inflammatory demyelinating polyradiculoneuropathy mimicking rapid-onset Guillain-Barré syndrome: a case report.
abstract: Nivolumab, an anti-programmed death-1-specific monoclonal antibody, has demonstrated a durable response and effect on overall survival and has become one of the standard treatments for patients with advanced melanoma. Reported herein is a case of nivolumab-induced chronic inflammatory demyelinating polyradiculoneuropathy, in which an 85-year-old woman with stage IV melanoma developed grade 1 paresthesia 2 weeks after the initial dose of nivolumab was administered. With continued treatment, the neurological deficiency deteriorated rapidly, mimicking Guillain-Barré syndrome, causing such a dramatic decrease in her activities of daily living that she could no longer function in daily life. Thus, nivolumab treatment was discontinued. A course of intravenous immunoglobulin infusion yielded a dramatic clinical improvement; in particular, improved motor control was observed within a few days. Her initial presentation was suggestive of acute inflammatory demyelinating polyradiculoneuropathy, a subtype of Guillain-Barré syndrome; however, the good response to steroids and exacerbation 8 weeks after the onset were suggestive of chronic inflammatory demyelinating polyradiculoneuropathy induced by nivolumab. This is the first case of Guillain-Barré syndrome-like autoimmune polyradiculoneuropathy induced by programmed death-1/programmed death-ligand 1 inhibitors. Although neurological adverse events related to nivolumab are rare, they can become severe, requiring early diagnosis and intervention. Intravenous immunoglobulin may be considered as an effective initial treatment for patients who develop acute autoimmune nervous system disorders due to nivolumab.
authors.affiliation: Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki ryota621@hotmail.co.jp.
authors.forename: Ryota
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tomidokoro
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Kumi
authors.initials: K
authors.lastname: Yanagiha
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Takumi
authors.initials: T
authors.lastname: Hirabayashi
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ishii
authors.affiliation: Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Mari
authors.initials: M
authors.lastname: Okune
authors.affiliation: Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Sae
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Sekine
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Akira
authors.initials: A
authors.lastname: Tamaoka
authors.affiliation: Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki.
authors.forename: Manabu
authors.initials: M
authors.lastname: Fujimoto
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D066193:Cervical Cord / Q000000981:diagnostic imaging; D005260:Female; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008545:Melanoma / Q000188:drug therapy; D000077594:Nivolumab; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000175:diagnosis* / Q000209:etiology; D012878:Skin Neoplasms / Q000188:drug therapy
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D000077594:Nivolumab
keywords: adverse events; immunoglobulin; melanoma; neuropathy; nivolumab