Premium
Multifocal radiculoneuropathy during ipilimumab treatment of melanoma
Author(s) -
Manousakis Georgios,
Koch James,
Sommerville R. Brian,
ElDokla Ahmed,
Harms Matthew B.,
AlLozi Muhammad T.,
Schmidt Robert E.,
Pestronk Alan
Publication year - 2013
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.23830
Subject(s) - ipilimumab , medicine , polyradiculoneuropathy , discontinuation , weakness , melanoma , surgery , pathology , immunotherapy , cancer , immunology , guillain barre syndrome , cancer research
Ipilimumab, a monoclonal anti–CTLA‐4 antibody, is used to treat melanoma. Neuromuscular side effects, possibly autoimmune, may occur. Methods: In this investigation we undertook a retrospective review of patient records. Results: After 3 doses of ipilimumab, a 31‐year‐old man developed asymmetric, severe weakness involving all limbs, respiration, and cranial nerves, which was progressive over 2 weeks. EMG/NCS showed an axonal polyradiculoneuropathy with multifocal motor conduction blocks. CSF protein was 749 mg/dl. Nerve pathology showed inflammation around the endoneurial microvessels and subperineurial edema and inflammation. Spine MRI showed leptomeningeal and anterior and posterior root enhancement. Strength improved slowly over months after ipilimumab discontinuation and immunomodulating treatment. Conclusions: Ipilimumab toxicity presented as a monophasic, multifocal, asymmetric polyradiculoneuropathy involving roots and peripheral and cranial nerves. Ipilimumab may produce a polyradiculoneuropathy with disruption of the blood–nerve barrier due to a microvasculopathy. Muscle Nerve 48 : 440–444, 2013