Nivolumab-induced chronic inflammatory demyelinating polyradiculoneuropathy mimicking rapid-onset Guillain–Barré syndrome: a case report

Abstract

Nivolumab, an anti-programmed death-1-specific monoclonal antibody, has demonstrated a durable response and effect on overall survival and has become one of the standard treatments for patients with advanced melanoma. Reported herein is a case of nivolumab-induced chronic inflammatory demyelinating polyradiculoneuropathy, in which an 85-year-old woman with stage IV melanoma developed grade 1 paresthesia 2 weeks after the initial dose of nivolumab was administered. With continued treatment, the neurological deficiency deteriorated rapidly, mimicking Guillain-Barré syndrome, causing such a dramatic decrease in her activities of daily living that she could no longer function in daily life. Thus, nivolumab treatment was discontinued. A course of intravenous immunoglobulin infusion yielded a dramatic clinical improvement; in particular, improved motor control was observed within a few days. Her initial presentation was suggestive of acute inflammatory demyelinating polyradiculoneuropathy, a subtype of Guillain-Barré syndrome; however, the good response to steroids and exacerbation 8 weeks after the onset were suggestive of chronic inflammatory demyelinating polyradiculoneuropathy induced by nivolumab. This is the first case of Guillain-Barré syndrome-like autoimmune polyradiculoneuropathy induced by programmed death-1/programmed death-ligand 1 inhibitors. Although neurological adverse events related to nivolumab are rare, they can become severe, requiring early diagnosis and intervention. Intravenous immunoglobulin may be considered as an effective initial treatment for patients who develop acute autoimmune nervous system disorders due to nivolumab.

Chronic inflammatory demyelinating polyneuropathy and malignancy: A systematic review

“…Table details reports of associated melanoma and CIDP. There are a dozen reported cases of CIDP and melanoma, excluding patients who developed CIDP as a result of melanoma immunotherapy, vaccination by melonoma lysates, interferon α‐2b, and, more recently, immune check‐point inhibitors . With melanoma lysates and interferon α‐2b, implication of the melanoma appeared possible, particularly in the latter case because the patient had been untreated for 40 weeks before neurological presentation.…”

Acute demyelinating polyneuropathy induced by nivolumab

“…Recent studies reported on acute or chronic demyelinating polyneuropathy induced by the treatment with immune checkpoint inhibitors 2 3. Tanaka et al 3 described a case of nivolumab-induced acute-onset chronic inflammatory demyelinating polyneuropathy (CIDP) relapsed by tapering corticosteroids after more than 6 months from onset. In our case, the neurological symptoms and electrophysiological findings dramatically improved by the administration of IVIg.…”

Nivolumab-Induced Severe Akathisia in an Advanced Lung Cancer Patient

“…Symptoms experienced by our patient were so severe that we could hardly manage them, and we could not identify effective drugs to control them. Recently, Tanaka et al [7] reported the efficacy of intravenous immunoglobulin administration, with which we did not challenge our patient, for nivolumab-induced Guillain-Barré syndrome.…”

“…Of those, autoimmune encephalitis [6] and Guillain-Barré syndrome [7] have been reported as nivolumab-induced neuropathy; however, up of now, akathisia or akathisia-like neuropathy has not been reported. Symptoms experienced by our patient were so severe that we could hardly manage them, and we could not identify effective drugs to control them.…”