Recurrent dysphasia due to nivolumab-induced encephalopathy with presence of Hu autoantibody

Jo Raskin; Pegah Masrori; Antonin Cant; Annemie Snoeckx; Birgitta Hiddinga; Sisca Kohl; Annelies Janssens; Patrick Cras; Jan P Van Meerbeeck

doi:10.1016/j.lungcan.2017.05.002

Recurrent dysphasia due to nivolumab-induced encephalopathy with presence of Hu autoantibody

Lung Cancer. 2017 Jul:109:74-77. doi: 10.1016/j.lungcan.2017.05.002. Epub 2017 May 10.

Authors

Jo Raskin¹, Pegah Masrori², Antonin Cant², Annemie Snoeckx³, Birgitta Hiddinga⁴, Sisca Kohl⁴, Annelies Janssens⁴, Patrick Cras⁵, Jan P Van Meerbeeck⁶

Affiliations

¹ Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium. Electronic address: jo.raskin@uza.be.
² Department of Neurology, Antwerp University Hospital, Edegem, Belgium.
³ Department of Radiology, Antwerp University Hospital, Edegem, Belgium.
⁴ Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium.
⁵ Department of Neurology, Antwerp University Hospital, Edegem, Belgium; Born Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
⁶ Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium; Center for Oncological Research, University of Antwerp, Antwerp, Belgium.

PMID: 28577954
DOI: 10.1016/j.lungcan.2017.05.002

Abstract

A 58-year-old man was being treated for squamous non-small-cell lung cancer with nivolumab. At the 17th of biweekly administrations he presented with global dysphasia, dysarthria and myoclonus in the right upper extremity. MRI showed multiple T2/FLAIR hyperintense lesions in the left hemisphere; lumbar puncture showed lymphocytic pleiocytosis in the CSF without identifiable pathogens. Hu antibodies were present in serum and CSF. Nivolumab was discontinued and corticosteroids were administered. The neurological symptoms gradually improved; MRI showed complete remission of cerebral lesions. After rechallenge with nivolumab his symptoms and cerebral lesions recurred, proving the causal relationship with nivolumab. After tapering of corticosteroids, a second relapse occurred.

Keywords: Dysphasia; Hu paraneoplastic antibody; Immune-related adverse event; Neurological toxicity; Nivolumab; Non-small-cell lung cancer.

Publication types

Case Reports

MeSH terms

Antibodies, Monoclonal / adverse effects
Antibodies, Monoclonal / therapeutic use*
Antineoplastic Agents / adverse effects
Antineoplastic Agents / therapeutic use*
Aphasia / diagnosis*
Aphasia / etiology
Autoantibodies / blood
Brain Diseases / diagnosis*
Brain Diseases / etiology
Carcinoma, Squamous Cell / complications
Carcinoma, Squamous Cell / diagnosis*
Carcinoma, Squamous Cell / drug therapy
Dexamethasone / therapeutic use*
Drug-Related Side Effects and Adverse Reactions / diagnosis*
ELAV Proteins / immunology
Humans
Immunotherapy / adverse effects
Immunotherapy / methods*
Lung / diagnostic imaging*
Lung Neoplasms / complications
Lung Neoplasms / diagnosis*
Lung Neoplasms / drug therapy
Magnetic Resonance Imaging
Male
Middle Aged
Nivolumab
Recovery of Function
Recurrence

Substances

Antibodies, Monoclonal
Antineoplastic Agents
Autoantibodies
ELAV Proteins
Nivolumab
Dexamethasone