Differential diagnosis in immune checkpoint inhibitors neurotoxicity.

IF 4.8 2区医学 Q1 CLINICAL NEUROLOGY Journal of Neurology Pub Date : 2025-01-15 DOI:10.1007/s00415-024-12872-6

Catherine R Garcia, Ian J Robertson, Timothy A Gregory, Anza Zahid, Behrang Amini, Carlos Kamiya-Matsuoka, Sudhakar Tummala

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Abstract

Background: Neurologic symptoms seen in patients receiving immune checkpoint inhibitors (ICI) may not be entirely caused by immunotoxicity. We aim to highlight these confounding conditions through clinical cases to encourage early recognition and management.

Methods: We describe a series of seven cases from our institution that were treated with ICI and presented with Neurologic symptoms and were diagnosed with superimposed conditions beyond immunotoxicity.

Results: A total of 7 cases are described that include acute motor axonal neuropathy with vitamin B12 deficiency, lumbosacral radiculopathy with Wernicke's, Herpes simplex virus (HSV) encephalitis reactivation, central nervous system vasculitis with renal vasculitis, myositis with fasciitis, myositis with fixed clinical deficit at resolution, and synovitis with accompanying carpal tunnel syndrome. Primary cancer site included lung adenocarcinoma (2/7), melanoma (4/7), and oropharyngeal squamous cell carcinoma (1/7). All patients had received treatment with more than one ICI. Median number of cycles prior to neurotoxicity was 3 cycles.

Discussion: Neurologic symptoms seen in patients receiving ICI may include other causes beyond immunotoxicity.

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免疫检查点抑制剂神经毒性的鉴别诊断。

背景：接受免疫检查点抑制剂（ICI）治疗的患者出现的神经系统症状可能不完全是由免疫毒性引起的。我们的目标是通过临床病例来强调这些混杂的情况，以鼓励早期识别和管理。方法：我们描述了来自我们机构的一系列7例，这些病例接受了ICI治疗，并表现出神经系统症状，并被诊断为免疫毒性以外的叠加条件。结果：报告了急性运动轴索神经病伴维生素B12缺乏症、腰骶神经根病伴韦尼克病、单纯疱疹病毒（HSV）脑炎再激活、中枢神经系统血管炎伴肾血管炎、肌炎伴筋膜炎、肌炎伴固定临床缺陷消退、滑膜炎伴腕管综合征共7例。原发癌部位包括肺腺癌（2/7）、黑色素瘤（4/7）和口咽鳞状细胞癌（1/7）。所有患者均接受了一次以上的ICI治疗。神经毒性前的中位周期数为3个周期。讨论：ICI患者出现的神经系统症状可能包括免疫毒性以外的其他原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.