Limbic encephalitis following immunotherapy against metastatic malignant melanoma.

Abstract

Novel immunotherapies are increasingly being used to treat malignant melanoma. The use of such agents has been associated with triggering autoimmunity. However, there has been a paucity in reports of limbic encephalitis associated with these immunotherapies. Pembrolizumab, a monoclonal antibody against programmed cell death antigen (PD-1), is currently being trialled in the UK to treat malignant melanoma. We report a unique case of antibody-negative limbic encephalitis presenting 1 year after starting pembrolizumab, in the context of malignant melanoma. The patient presented with progressive cognitive decline. MRI of the brain revealed signal change within the limbic structures. Cerebrospinal fluid studies confirmed evidence of inflammation with raised white cell count and protein. We were able to prevent further progression of symptoms by stopping pembrolizumab and treating the patient instead with steroids. We advocate considering autoimmune neuroinflammation as a differential for neurological disorders presenting in patients receiving PD-1 antagonist treatment and immunotherapy in general.

• Authors: Sharfaraz Salam, Timothy Lavin, Ayse Turan
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2016 (Mar 23 2016) ISSN: 1757-790X [Electronic] England
• PMID: 27009198 (Publication Type: Case Reports, Journal Article)
• Copyright: 2016 BMJ Publishing Group Ltd.

Chemical References

• Antibodies, Monoclonal, Humanized
• Steroids
• pembrolizumab

Topics

• Antibodies, Monoclonal, Humanized (adverse effects)
• Humans
• Limbic Encephalitis (chemically induced, diagnostic imaging)
• Male
• Melanoma (drug therapy)
• Middle Aged
• Neoplasm Metastasis
• Steroids (therapeutic use)
• Treatment Outcome