Immune checkpoint inhibitors (ICIs) have been approved for the treatment of various malignancies with promising clinical outcomes. Treatment can, however, be accompanied by serious immune-related adverse events. Neurological adverse events like Guillain-Barré syndrome (GBS) are rare but potentially lifethreatening. We present 3 cases of ICI-related GBS; review cases described in current literature, and discuss treatment strategies. Three patients developed GBS after ICI treatment. The first case with pembrolizumab had a fatal outcome despite treatment with multiple regimens, including steroids and intravenous immunoglobulin (IVIg). The other 2 cases with nivolumab-induced and pembrolizumab-induced GBS, respectively, responded well to treatment with IVIg and steroids. In the current literature, a total of 31 other cases were found. Treatment for ICI-related GBS mostly consisted of concurrent IVIg and steroids (44%), which led to clinical improvement in 73%. Most patients recovered with remaining symptoms (68%), while 10 patients developed respiratory failure (29%) and 6 patients (18%) died. ICI-related GBS should be suspected in patients on ICI treatment who develop subacute progressive weakness of the limbs, sensory loss, and areflexia. On the basis of the guidelines recommendations and our review of the literature, we advise first-line therapy with concurrent IVIg 0.4 g/kg/d for 5 days and prednisolone 1-2 mg/kg/d. Discontinuation of immunotherapy after ICI-related GBS is advised.

Mycobacterium abscessus (M. abscessus) is a rapidly growing nontuberculous mycobacterium (NTM), often dubbed the 'antibiotic nightmare' for its extensive resistance to antibiotics. 1 Pulmonary infections, skin and soft tissue infections are its most frequent clinical manifestations, but otomastoiditis is also an established clinical entity. 2 Treatment is difficult due to the multidrug resistance and lack of international consensus on therapeutic options as well as duration of treatment.A previous study at our institute suggested a 6-month antibiotic treatment strategy combining systemic and local treatment. 3 This intensive, long-term antibiotic regimen proved effective, but severely affects children's wellbeing. Children need a peripherally inserted central catheter (PICC) for long-term intravenous antibiotics and both surgery and antibiotic treatment may induce hearing loss (HL).Adverse events (AE) such as nausea and vomiting, myelosuppression, toxic dermatitis and liver toxicity are frequent and the psychosocial impact of the treatment is thought to be the severe. 3 Therefore, the assessment of quality of life (QoL) during and after treatment is important. This study aims to evaluate adverse events and QoL after treatment for M. abscessus otomastoiditis. | ME THODS | DesignA retrospective analysis of QoL from patients treated for M. abscessus otomastoiditis at our referral centre was performed. Informed consent was obtained from the guardians and children above 12 years old. Guardians and patients were invited by phone.

Background This paper reports a case of chondrosarcoma deriving from the left arytenoid cartilage that was resected via an anterior laryngofissure using the Tritube in situ, thus eliminating the need for a (temporary) tracheostomy. Case report A 49-year-old male with a chondrosarcoma deriving from the left arytenoid was treated with local resection of the tumour through an anterior laryngofissure. The intralaryngeal lumen was too small for a normal endotracheal tube. Using the Tritube (outer diameter, 4.4 mm), the patient could be intubated and ventilated adequately during the procedure. The Tritube did not obstruct the surgical view during the procedure. Conclusion The Tritube can be used for intubation and ventilation even in patients with a very narrow airway lumen, and does not obstruct the field of view during open laryngeal surgery, thereby avoiding the need for peri-operative tracheostomy.

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