Acute Cerebellar Ataxia Induced by Nivolumab

Abstract

A 54-year-old woman with adenocarcinoma of the lung and lymph node metastasis experienced nystagmus and cerebellar ataxia 2 weeks after initiating nivolumab therapy. An evaluation for several autoimmune-related antibodies and paraneoplastic syndrome yielded negative results. We eventually diagnosed the patient with nivolumab-induced acute cerebellar ataxia, after excluding other potential conditions. Her ataxic gait and nystagmus resolved shortly after intravenous steroid pulse therapy followed by the administration of decreasing doses of oral steroids. Nivolumab, an immune checkpoint inhibitor, is known to induce various neurological adverse events. However, this is the first report of acute cerebellar ataxia associated with nivolumab treatment.

Nivolumab‐associated Lambert‐Eaton myasthenic syndrome and cerebellar dysfunction in a patient with a neuroendocrine tumor

“…Although the presenting cerebellar symptoms likely resulted from the cerebellar metastasis, the cerebellar symptoms after nivolumab initiation were likely a neurologic irAE, as previously reported. 4,5 VGCC autoantibody-positive LEMS and SCD have been reported to co-occur, 6 and we postulate that nivolumab triggered both VGCC-mediated paraneoplastic diseases in this patient.…”

“…Nerve conduction studies showed a sensory neuronopathy (Table 1). 5 However, electromyography (EMG) revealed findings suggestive of a disorder of muscle membrane function/non-dystrophic myotonia ( LETTER TO THE EDITOR E21…”

Neurological immune‐related adverse events associated with immune checkpoint inhibitors: A review of the literature

“…We searched PubMed for irEncephalitis (including meningoencephalitis, encephalomyelitis, and cerebellitis) cases and identified 60 patients (Tables 1 and S1), 22,32‐73 35 (58.3%) of which were males. The median onset age was 60 years (interquartile range, IQR: 53‐69; range: 19‐83).…”

Steroid-responsive Nivolumab-induced Involuntary Movement with Anti-thyroid Antibodies

“…To our knowledge, there have been no reports of nivolumab-induced Hashimoto's encephalopathy. Kawamura et al described a patient who had nivolumab-induced acute cerebellar ataxia with slight elevation of anti-TPO antibody level (25 U/mL), but they also did not examine the anti-NAE antibody level (6). Further reports are needed in order to clarify the associations between pathogenic autoantibodies and irAEs, especially those associated with involuntary movement.…”