MULTIFOCAL RADICULONEUROPATHY DURING IPILIMUMAB TREATMENT OF MELANOMA
MULTIFOCAL RADICULONEUROPATHY DURING IPILIMUMAB TREATMENT OF MELANOMA
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DOI：
10.1002/mus.23830
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发表时间：
2013-09-01
期刊：
影响因子：
3.4
通讯作者：
Pestronk, Alan
中科院分区：
文献类型：
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作者：
Manousakis, Georgios;Koch, James;Pestronk, Alan
简介：Ipilimumab是一种单克隆抗CTLA-4抗体，用于治疗黑色素瘤。可能发生神经肌肉副作用，可能是自身免疫性。方法：在这项调查中，我们进行了回顾性审查的病人记录。结果如下：1例31岁男性在接受3剂伊匹单抗后出现不对称、严重无力，累及所有肢体、呼吸和颅神经，在2周内进行性。EMG/NCS显示轴突多神经根神经病伴多灶性运动传导阻滞。CSF蛋白为749 mg/dl。神经病理学显示神经内膜微血管周围炎症以及神经束膜下水肿和炎症。脊柱MRI显示软脑膜和前、后根增强。在伊匹单抗停药和免疫调节治疗后的几个月内，力量缓慢改善。结论：伊匹单抗毒性表现为累及神经根、外周神经和颅神经的单相、多灶性、不对称性多神经根神经病。易普利姆玛可能会产生多神经根神经病，并因微血管病变而破坏血神经屏障。肌肉神经48：440-444，2013
Introduction: 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 Nerve48: 440-444, 2013