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Author Notes:

Lorraine Cafuir, Email:lcafuir@emory.edu

LC drafted and revised the manuscript for intellectual content.

DL treated the patient, conceptualized this case report and helped revise the manuscript.

ND provided the images and their interpretation and wrote a section of the manuscript.

VK provided the nerve conduction study data and its interpretation.

AV consulted in the care of the patient, helped revise the manuscript for intellectual content.

All authors read and approved the final manuscript.

All data analyzed are included in this article and additional information is available upon request.

Ethics approval and consent to participate: Not applicable, not a clinical trial.

Consent for publication: Not required by our local IRB if patient is deceased.

DL participates in pharmaceutical trials sponsored by Bristol-Myers Squibb, the maker of Ipilimumab.

VK is the Principal Investigator for the NN103 Myasthenia Gravis Study funded by the NIH

LC, ND, and AV declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Immunology
  • Ipilimumab
  • Melanoma
  • Leptomeningeal carcinomatosis
  • Inflammatory demyelinating polyneuropathy
  • Autoimmune
  • Immunotherapy
  • Paraneoplastic autoimmune disease
  • METASTATIC MELANOMA

Inflammatory demyelinating polyneuropathy versus leptomeningeal disease following Ipilimumab

Tools:

Journal Title:

Journal for ImmunoTherapy of Cancer

Volume:

Volume 6, Number 1

Publisher:

, Pages 11-11

Type of Work:

Article | Final Publisher PDF

Abstract:

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. Case presentation: A 42year 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. Conclusion: Ipilimumab immune-related toxicity presented as inflammatory demyelinating polyneuropathy, which was difficult to distinguish from leptomeningeal disease, a common complication of melanoma.

Copyright information:

© 2018 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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