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Yuen CA, Rezania K, Park DM, Reder AT. Asymptomatic brainstem lesions and pachymeningeal enhancement after anti-PD-1 therapy. Immunotherapy 2020; 13:11-17. [PMID: 33023359 DOI: 10.2217/imt-2020-0186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neurological immune-related adverse events (irAEs) are rare toxicities that occur following immune checkpoint inhibitor therapy. We propose that patients with thymic malignancies and graft-versus-host disease (GVHD) are predisposed to irAEs. We present two asymptomatic patients, one with thymoma and another with GVHD, who developed abnormal brain MRIs after treatment with programmed cell death protein 1 inhibitors. The first patient, with thymic cancer and thymoma, developed pontine enhancing MRI lesions following treatment with pembrolizumab. The second patient, with prior GVHD, developed pachymeningeal enhancement following treatment with nivolumab. IrAEs with abnormal MRI studies, despite asymptomatology, have significant impact on the treatment strategy for these patients.
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Affiliation(s)
- Carlen A Yuen
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Kourosh Rezania
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Deric M Park
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Anthony T Reder
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA
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Pirotte M, Forte F, Lutteri L, Willems E, Duran U, Belle L, Baron F, Beguin Y, Maquet P, Bodart O, Servais S. Neuronal surface antibody-mediated encephalopathy as manifestation of chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. J Neuroimmunol 2018; 323:115-118. [PMID: 30189384 DOI: 10.1016/j.jneuroim.2018.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
Although it remained controversial for a long time, central nervous system (CNS) involvement of graft-versus-host disease (GVHD) is now becoming recognized as a real nosological entity. Previous case reports have suggested heterogeneous clinical presentations and it is not excluded that the whole spectrum of manifestations has not yet been fully described. Here, we report the case of a 58-year-old man with chronic GVHD who developed a rapidly ingravescent encephalopathy. There was no evidence for CNS immune-mediated lesions on conventional imaging nor for cellular infiltration in the cerebrospinal fluid. Serum analyses revealed the presence of anti-neuronal antibodies directed against anti-contactin-associated protein 2 (anti-Caspr2), a protein associated with voltage-gated potassium neuronal channels. Functional imaging with 2-deoxy-2-[fluorine-18] fluoro- d-glucose integrated with computed tomography (18F-FDG PET-CT) demonstrated diffuse cortical and subcortical hypometabolism. The patient was treated with a combination of immunosuppressive agents (corticosteroids, cyclophosphamide and rituximab) and progressively recovered normal neurocognitive functions. Taken together, these data suggest that CNS-GVHD may manifest as a reversible antibody-mediated functional encephalopathy. This report suggests for the first time the interest of screening for anti-neuronal antibodies and functional imaging with brain 18F-FDG PET-CT in diagnosing this severe complication of allogeneic hematopoietic cell transplantation (alloHSCT).
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Affiliation(s)
- Michelle Pirotte
- Department of Hematology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Florence Forte
- Department of Neurology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Laurence Lutteri
- Department of Clinical Biology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Evelyne Willems
- Department of Hematology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Unal Duran
- Department of Radiology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Ludovic Belle
- Department of Hematology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Frédéric Baron
- Department of Hematology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Yves Beguin
- Department of Hematology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Pierre Maquet
- Department of Neurology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Olivier Bodart
- Department of Neurology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium
| | - Sophie Servais
- Department of Hematology, CHU of Liège and ULiege, CHU Sart-Tilman, 4000 Liège, Belgium.
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