Autopsy case of meningoencephalitis induced by nivolumab and ipilimumab in a patient being treated for non-small cell lung cancer

• Published in: Internal Medicine p. 3457-24
• Main Authors: Shiraha, Keisuke, Watanabe, Hiromi, Fujiwara, Keiichi, Goda, Mayu, Inoue, Tomoyoshi, Fujiwara, Miho, Matsuoka, Suzuka, Takigawa, Yuki, Mitsumune, Sho, Kudo, Kenichiro, Sato, Akiko, Sato, Ken, Shinno, Yoko, Shibayama, Takuo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 2024
• Subjects: autopsy; immune checkpoint inhibitor; ipilimumab; meningoencephalitis; nivolumab; immune checkpoint inhibitor; meningoencephalitis; nivolumab; autopsy; ipilimumab
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.3457-24

A 75-year-old woman with stage IVB (cT2bN3M1b) lung adenocarcinoma was administered nivolumab, ipilimumab, carboplatin, and paclitaxel. Fourteen days after receiving chemotherapy, she experienced an impaired consciousness and a cerebrospinal fluid analysis revealed high protein levels and pleocytosis. She was diagnosed with nivolumab- and ipilimumab-induced encephalitis and was treated with corticosteroids which were tapered to 10 mg/day, with no symptom recurrence. She died 18 weeks after the initial presentation, as the cancer worsened. An autopsy showed encephalitis and CD8+ lymphocyte infiltration around the blood vessels. Thus, immune-related adverse events should be suspected and treatment should be initiated for patients presenting with an impaired consciousness when concurrently being treated with nivolumab and ipilimumab.