Inflammatory demyelinating polyneuropathy versus leptomeningeal disease following Ipilimumab.
Inflammatory demyelinating polyneuropathy versus leptomeningeal disease following Ipilimumab.
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DOI：
10.1186/s40425-018-0318-x
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发表时间：
2018-01-30
影响因子：
10.9
通讯作者：
Voloschin A
中科院分区：
文献类型：
--
作者：
Cafuir L;Lawson D;Desai N;Kesner V;Voloschin A
Ipilimumab是FDA批准的用于治疗转移性黑色素瘤的抗CTLA-4单抗。我们介绍了伊匹单抗治疗的一种不寻常的神经系统并发症及其引起的诊断困境。一名42岁的男性，患有IV期转移性黑色素瘤，在服用三剂伊匹单抗后出现下肢无力和感觉神经病变。腰椎MRI最初被解释为弥漫性软脑膜疾病，患者开始接受地塞米松和放射治疗，症状有所改善。然而，随后的完整成像显示神经根受累光滑，脊髓未受侵犯，这一结果更符合炎症性脱髓鞘多神经病。脑脊液(CSF)中无恶性细胞和神经传导检查(NCS)显示伴有轴突受累和脱髓鞘特征的腰椎多根神经病支持炎性脱髓鞘多神经病的诊断。后来在他的病程中，病人出现了明显的软脑膜黑色素瘤。Ipilimumab免疫相关毒性表现为炎性脱髓鞘多神经病，与黑色素瘤的常见并发症软脑膜病难以区分。
Ipilimumab is an FDA-approved anti-CTLA-4 monoclonal antibody used in treatment of metastatic melanoma. We present an unusual neurological complication of Ipilimumab therapy and the diagnostic dilemma it caused. A 42 year old male with Stage IV metastatic melanoma developed lower extremity weakness and sensory neuropathy following three doses of Ipilimumab. MRI of the lumbar spine was initially interpreted as diffuse leptomeningeal disease, and patient began Dexamethasone and radiation with improvement in symptoms. However, subsequent completion imaging revealed smooth nerve root involvement with sparing of the spinal cord, findings more compatible with inflammatory demyelinating polyneuropathy. The absence of malignant cells in the cerebrospinal fluid (CSF) and nerve conduction study (NCS) showing lumbar polyradiculoneuropathy with axonal involvement and demyelinating features supported the diagnosis of inflammatory demyelinating polyneuropathy. Later in the course of his disease, the patient developed frank leptomeningeal melanoma. Ipilimumab immune-related toxicity presented as inflammatory demyelinating polyneuropathy, which was difficult to distinguish from leptomeningeal disease, a common complication of melanoma.
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影响因子：
--
作者：
Le Rhun E;Taillibert S;Chamberlain MC
通讯作者：
Chamberlain MC
影响因子：
15.9
作者：
Liao, Bing;Shroff, Sheetal;Tummala, Sudhakar
通讯作者：
Tummala, Sudhakar
影响因子：
3.4
作者：
Manousakis, Georgios;Koch, James;Pestronk, Alan
通讯作者：
Pestronk, Alan
影响因子：
4.7
作者：
NORONHA, AB;HARPER, JR;QUARLES, RH
通讯作者：
QUARLES, RH
DOI：
10.1111/j.1440-1673.2007.01793.x
发表时间：
2007-10-01
期刊：
AUSTRALASIAN RADIOLOGY
影响因子：
--
作者：
Kale, H. A.;Sklar, E.
通讯作者：
Sklar, E.