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Case Report
Neurological immune-related toxicity to ipilimumab/nivolumab therapy in malignant melanoma: A challenging case report
1 Doctor, Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil E.P.E., Porto, Portugal
2 Doctor, Neurology Department, Instituto Português de Oncologia do Porto Francisco Gentil E.P.E., Porto, Portugal
3 Doctor, Infectious Diseases Department, Instituto Português de Oncologia do Porto Francisco Gentil E.P.E., Porto, Portugal
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Diana Baptista da Mata
Rua Dr. António Bernardino de Almeida 865, 4200-072 Porto,
Portugal
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Article ID: 100135Z10DM2024
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How to cite this article
da Mata DB, Rodrigues PR, Oliveira V, Santos FV, Ferreira P. Neurological immune-related toxicity to ipilimumab/nivolumab therapy in malignant melanoma: A challenging case report. J Case Rep Images Oncology 2024;10(2):10–14.ABSTRACT
Introduction: Malignant melanoma poses a significant threat due to its aggressiveness and high fatality rates. Recent advances in immunotherapy and targeted molecular therapies have transformed the treatment landscape for advanced melanoma, improving overall survival. However, the rising use of immune checkpoint inhibitors (ICIs) introduces complexities, particularly in neurological immune-related adverse events (irAEs), necessitating careful consideration and multidisciplinary management.
Case Report: We report the case of a 77-year-old woman with stage IV cutaneous melanoma, which was hospitalized with polyneuropathy following immunotherapy treatment with ipilimumab and nivolumab combination. The complex presentation involved considerations of COVID-19 vaccination, detection of Epstein–Barr virus (EBV) in cerebrospinal fluid, and the challenge of distinguishing infectious from immune-related causes. The multidisciplinary team navigated multiple diagnostic uncertainties. The patient’s clinical evolution, including complications and treatment responses, provided insights into managing severe neurological irAEs associated with immunotherapy.
Conclusion: Neurologic immune-related (IR) toxicity is well established, and it may led to severe adverse events, which are complex to diagnose and manage. This case report highlights the challenges and difficulties found, with relevant confounding factors, which arise the relevance of the need of a multidisciplinary team to deal with neurologic immune-related toxicities.
Keywords: Immune-related adverse events, Immunotherapy, Melanoma, Polineuropahty
SUPPORTING INFORMATION
Author Contributions
Diana Baptista da Mata - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Patrícia Rafaela Rodrigues - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Vanessa Oliveira - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Fábio Videira Santos - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Paula Ferreira - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Diana Baptista da Mata et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
