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Autoimmune encephalitis associated with Ma2 antibodies and immune checkpoint inhibitor therapy
  1. Shane Lyons1,
  2. Ronan Joyce1,
  3. Patrick Moynagh1,
  4. Luke O'Donnell1,
  5. Silive Blazkova2,
  6. Timothy J Counihan1,3
  1. 1Neurology Department, University Hospital Galway, Galway, Ireland
  2. 2Oncology Department, University Hospital Galway, Galway, Ireland
  3. 3National University of Ireland Galway, Galway, Ireland
  1. Correspondence to Dr Shane Lyons, University Hospital Galway, Galway H91 YR71, Ireland; shane.lyons{at}ndcn.ox.ac.uk

Abstract

Immune checkpoint inhibitors have transformed the treatment of advanced malignancy, while increasing the risk of immune-related adverse events. A 56-year-old woman who had received nivolumab for stage 4 renal cell carcinoma subsequently developed altered behaviour, memory deficits and worsening of previously stable epilepsy. MR scan of the brain showed bilateral FLAIR (fluid-attenuated inversion recovery) hyperintensity of the mesial temporal lobes, and there were anti-Ma2 antibodies in both serum and cerebrospinal fluid. She was treated with corticosteroids but developed further clinical relapses requiring immunoglobulin and rituximab. The immune-related adverse events relating to immune checkpoint inhibitors are an emerging challenge for the neurologist. Some cases are refractory and require serial immunosuppression.

  • immune checkpoint inhibitor
  • anti-PD1
  • encephalitis
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Footnotes

  • SL and RJ contributed equally.

  • Contributors SL and RJ drafted the manuscript. PM and LOD reviewed and edited the manuscript. SB and TJC reviewed, revised and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Sarosh Irani, Oxford, UK.

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