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Motor polyradiculopathy during pembrolizumab treatment of metastatic melanoma
Author(s) -
Sepúlveda Maria,
MartinezHernandez Eugenia,
Gaba Lydia,
Victoria Ivan,
SolaValls Nuria,
Falgàs Neus,
CasanovaMolla Jordi,
Graus Francesc
Publication year - 2017
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.25672
Subject(s) - pembrolizumab , medicine , polyradiculopathy , weakness , multifocal motor neuropathy , muscle atrophy , muscle weakness , melanoma , surgery , atrophy , anesthesia , oncology , cancer , immunotherapy , mismatch negativity , electroencephalography , cancer research , psychiatry
Pembrolizumab, a monoclonal antibody directed against the immune checkpoint programmed cell death‐1 receptor (PD‐1), has improved survival in patients with advanced melanoma. Neuromuscular immune‐mediated side effects have been rarely reported. Methods We describe a 44‐year‐old man with metastatic melanoma who presented with progressive muscle weakness after 23 doses of pembrolizumab. Results The patient developed asymmetric, proximal muscle weakness and atrophy in all four limbs. Cerebrospinal fluid examination showed albuminocytologic dissociation. MRI revealed contrast enhancement of the lumbosacral roots. Electrodiagnostic studies demonstrated widespread fibrillation potentials in all four limbs, suggesting a generalized motor polyradiculopathy. Despite pembrolizumab discontinuation and treatment with steroids and intravenous immunoglobulin, limb weakness worsened. Electrodiagnostic studies were repeated, and showed marked and diffuse axonal motor damage. Seven weeks after clinical onset the patient was treated with plasma exchanges. He showed no further deterioration. Discussion We report a severe motor polyradiculopathy associated with an anti‐PD‐1 agent that expands the spectrum of neuromuscular complications of this class of drugs. Muscle Nerve 56 : E162–E167, 2017