TY - JOUR
TI - Inflammatory Myopathy and Axonal Neuropathy in a Patient with Melanoma Following Pembrolizumab Treatment
AU - Diamantopoulos, P.T.
AU - Tsatsou, K.
AU - Benopoulou, O.
AU - Anastasopoulou, A.
AU - Gogas, H.
JO - Journal of Immunotherapy
PY - 2017
VL - 40
TODO - 6
SP - 221-223
PB - Lippincott Williams and Wilkins
SN - 1524-9557
TODO - 10.1097/CJI.0000000000000172
TODO - immunoglobulin;  pembrolizumab;  prednisolone;  immunological antineoplastic agent;  monoclonal antibody;  pembrolizumab;  programmed death 1 receptor, aged;  Article;  axon;  case report;  cerebrospinal fluid cytology;  cervical spine;  computer assisted tomography;  diplopia;  dysphagia;  electromyogram;  enzyme linked immunosorbent assay;  hoarseness;  human;  in-transit metastasis;  laryngoscopy;  male;  melanoma;  miosis;  muscle biopsy;  muscle weakness;  myositis;  neck pain;  neuromuscular junction disorder;  neuropathy;  physical examination;  polyneuropathy;  priority journal;  ptosis;  respiratory failure;  shoulder pain;  single drug dose;  skin ulcer;  tendon reflex;  thyroid function;  very elderly;  adverse drug reaction;  axon;  cancer staging;  complication;  fatality;  immunology;  immunotherapy;  melanoma;  myositis;  pathology;  peripheral neuropathy;  procedures, Aged, 80 and over;  Antibodies, Monoclonal, Humanized;  Antineoplastic Agents, Immunological;  Axons;  Blepharoptosis;  Drug-Related Side Effects and Adverse Reactions;  Fatal Outcome;  Humans;  Immunotherapy;  Male;  Melanoma;  Myositis;  Neoplasm Staging;  Peripheral Nervous System Diseases;  Programmed Cell Death 1 Receptor
TODO - 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. © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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