Limbic encephalitis following immunotherapy against metastatic malignant melanoma

Novel immunotherapies are increasingly being used to treat malignant melanoma. The use of such agents has been associated with triggering autoimmunity. However, there has been a paucity in reports of limbic encephalitis associated with these immunotherapies. Pembrolizumab, a monoclonal antibody agai...

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Bibliographic Details
Published in:BMJ case reports 2016-03, Vol.2016, p.bcr2016215012
Main Authors: Salam, Sharfaraz, Lavin, Timothy, Turan, Ayse
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal, Humanized - adverse effects
Cellular biology
Cognition & reasoning
Humans
Immunoglobulins
Immunotherapy
Kinases
Ligands
Limbic Encephalitis - chemically induced
Limbic Encephalitis - diagnostic imaging
Lymphocytes
Male
Melanoma
Melanoma - drug therapy
Memory
Metastasis
Middle Aged
Neoplasm Metastasis
Nervous system
New Disease
Potassium
Proteins
Skin cancer
Steroids - therapeutic use
Syphilis
Treatment Outcome
United Kingdom
Viruses
White
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Summary:Novel immunotherapies are increasingly being used to treat malignant melanoma. The use of such agents has been associated with triggering autoimmunity. However, there has been a paucity in reports of limbic encephalitis associated with these immunotherapies. Pembrolizumab, a monoclonal antibody against programmed cell death antigen (PD-1), is currently being trialled in the UK to treat malignant melanoma. We report a unique case of antibody-negative limbic encephalitis presenting 1 year after starting pembrolizumab, in the context of malignant melanoma. The patient presented with progressive cognitive decline. MRI of the brain revealed signal change within the limbic structures. Cerebrospinal fluid studies confirmed evidence of inflammation with raised white cell count and protein. We were able to prevent further progression of symptoms by stopping pembrolizumab and treating the patient instead with steroids. We advocate considering autoimmune neuroinflammation as a differential for neurological disorders presenting in patients receiving PD-1 antagonist treatment and immunotherapy in general.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2016-215012