Inflammatory Myopathy and Axonal Neuropathy in a Patient With Melanoma Following Pembrolizumab Treatment

Journal of Immunotherapy
Panagiotis T DiamantopoulosHelen Gogas

Abstract

Immune-mediated adverse effects of immune checkpoint inhibitors are rather common, but neuromyopathic immune-related adverse events are very rare. In this report, we present a unique case of a patient with a complex neuromyopathic syndrome with axonal neuropathy and inflammatory myopathy after a single dose of pembrolizumab. An 82-year-old patient with a previously untreated stage IIIc melanoma developed ptosis in the left eye, generalized weakness, and neck and shoulder pain 15 days after pembrolizumab administration. He had left-sided ptosis and miosis, with a normal pupillary light reflex, horizontal diplopia, and voice hoarseness, along with weakness of the neck muscles and a hypokinetic right vocal cord at laryngoscopy. The laboratory evaluation was remarkable for the marked increase in the serum lactate dehydrogenase and creatine phosphokinase levels. Further evaluation revealed findings compatible with axonal neuropathy and inflammatory myopathy. The patient was treated with corticosteroids, immunoglobulin, and plasmapheresis, with a minor response; the patient eventually died. This case represents a newly described syndrome probably associated with pembrolizumab administration.

References

May 1, 1990·Archives of Dermatology·J K RiversW H McCarthy
Dec 1, 1995·The British Journal of Dermatology·G Sais
Apr 20, 2010·Arthritis Research & Therapy·Yi-Ju ChenYun-Ting Chang
Feb 26, 2013·Arthritis Care & Research·John C HallLisa Christopher-Stine
May 21, 2015·American Society of Clinical Oncology Educational Book·Michael A Postow
May 23, 2015·Auto- Immunity Highlights·Anna GhirardelloAndrea Doria
Jan 24, 2016·Muscle & Nerve·Julia Zhu, Yuebing Li
Apr 12, 2016·Muscle & Nerve·K H Vincent LauRichard J Nowak
Jul 16, 2016·Cancer Science·Toshihiro KimuraHironobu Ihn

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Citations

Dec 5, 2017·Journal of Immunotherapy·Teerin LiewluckMichelle L Mauermann
Aug 6, 2018·Current Neurology and Neuroscience Reports·Justin C KaoTeerin Liewluck
Feb 23, 2020·Annals of Neurology·Divyanshu DubeyAmanda C Guidon
Feb 23, 2019·Current Rheumatology Reports·Hiroko KadotaMasataka Kuwana
May 26, 2018·Journal of Clinical Neuromuscular Disease·David Lacomis
Aug 27, 2019·Current Opinion in Ophthalmology·Vivian Paraskevi DouglasDean M Cestari
Dec 10, 2019·Rheumatology·Jan Leipe, Xavier Mariette
Nov 12, 2020·Eye and Brain·Caberry W YuJonathan A Micieli
May 29, 2021·Frontiers in Neurology·Francesco BrunoRoberta Rudà

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