PDF(Pubmed)
Abstract：
UNASSIGNED: Immune-related adverse effects (irAEs) often occur during immune checkpoint inhibitor (ICI) therapy. In the nervous system, the incidence of irAEs ranges from 0.1-12%, with 80% occurring within the first 4 months of ICI application. For complications of the nervous system, adequate diagnosis is made by signs, symptoms, imaging and cerebrospinal fluid. If severe irAEs occur, ICIs should be discontinued and patients should be treated with high-dose glucocorticoids, immunoglobulins, or immunosorbent therapy with systemic support. Patients who develop severe neurologic irAEs have a poorer prognosis.
UNASSIGNED: In this article, we report 2 cases of encephalopathy induced by anti-programmed cell death protein 1 (PD-1) monoclonal antibodies at the initial diagnoses. Our findings may help clinicians to differentiate between encephalopathy caused by immunotherapy and other neurological disorders. Case 1 was a 24-year-old male patient who had undergone PD-1 immunotherapy to treat olfactory neuroblastoma. After the 6th course of therapy, he began to develop persistent epilepsy, which decreased significantly after high doses of glucocorticoid and immunosorbent therapy were administered. Based on his medical history and laboratory examination results, PD-1-induced encephalopathy was the most likely diagnosis. Case 2 was a 67-year-old female patient who had been treated with PD-1/programmed death ligand-1 therapy for lung adenocarcinoma. She began to have headaches after 1 cycle of treatment, and her cognitive function gradually decreased with the continuation of immunotherapy.
UNASSIGNED: These case reports show the difficulty in distinguishing PD-1-induced encephalopathy from other neurological disorders, especially paraneoplastic neurological syndromes. If not treated properly, patients\' lives may be endangered. Thus, early identification and early treatment are very important.
UNASSIGNED: In this article, we report 2 cases of encephalopathy induced by anti-programmed cell death protein 1 (PD-1) monoclonal antibodies at the initial diagnoses. Our findings may help clinicians to differentiate between encephalopathy caused by immunotherapy and other neurological disorders. Case 1 was a 24-year-old male patient who had undergone PD-1 immunotherapy to treat olfactory neuroblastoma. After the 6th course of therapy, he began to develop persistent epilepsy, which decreased significantly after high doses of glucocorticoid and immunosorbent therapy were administered. Based on his medical history and laboratory examination results, PD-1-induced encephalopathy was the most likely diagnosis. Case 2 was a 67-year-old female patient who had been treated with PD-1/programmed death ligand-1 therapy for lung adenocarcinoma. She began to have headaches after 1 cycle of treatment, and her cognitive function gradually decreased with the continuation of immunotherapy.
UNASSIGNED: These case reports show the difficulty in distinguishing PD-1-induced encephalopathy from other neurological disorders, especially paraneoplastic neurological syndromes. If not treated properly, patients\' lives may be endangered. Thus, early identification and early treatment are very important.
摘要：
■免疫检查点抑制剂（ICI）治疗期间经常发生与免疫相关的不良反应（irAE）。在神经系统中，IRAE的发生率范围为0.1-12%，80%发生在ICI申请的前4个月内。对于神经系统的并发症，通过体征进行充分的诊断，症状,影像学和脑脊液。如果发生严重的irAE，ICIs应该停止，患者应该接受大剂量糖皮质激素治疗，免疫球蛋白，或全身支持的免疫吸附疗法。发生严重神经系统疾病的患者预后较差。
■在本文中，我们报道了2例抗程序性细胞死亡蛋白1(PD-1)单克隆抗体在初次诊断时诱发的脑病.我们的发现可能有助于临床医生区分由免疫疗法引起的脑病和其他神经系统疾病。病例1是一名24岁的男性患者，曾接受PD-1免疫疗法治疗嗅觉神经母细胞瘤。第6个疗程后,他开始发展为持续性癫痫,给予高剂量糖皮质激素和免疫吸附治疗后显著下降。根据他的病史和实验室检查结果，PD-1诱发的脑病是最可能的诊断。病例2是一名67岁的女性患者，曾接受PD-1/程序性死亡配体-1治疗肺腺癌。经过1个周期的治疗，她开始头痛，随着免疫治疗的继续，她的认知功能逐渐下降。
■这些病例报告显示难以区分PD-1诱发的脑病和其他神经系统疾病，尤其是副肿瘤神经综合征.如果治疗不当,病人的生命可能会受到威胁。因此，早期识别和早期治疗非常重要。
■在本文中，我们报道了2例抗程序性细胞死亡蛋白1(PD-1)单克隆抗体在初次诊断时诱发的脑病.我们的发现可能有助于临床医生区分由免疫疗法引起的脑病和其他神经系统疾病。病例1是一名24岁的男性患者，曾接受PD-1免疫疗法治疗嗅觉神经母细胞瘤。第6个疗程后,他开始发展为持续性癫痫,给予高剂量糖皮质激素和免疫吸附治疗后显著下降。根据他的病史和实验室检查结果，PD-1诱发的脑病是最可能的诊断。病例2是一名67岁的女性患者，曾接受PD-1/程序性死亡配体-1治疗肺腺癌。经过1个周期的治疗，她开始头痛，随着免疫治疗的继续，她的认知功能逐渐下降。
■这些病例报告显示难以区分PD-1诱发的脑病和其他神经系统疾病，尤其是副肿瘤神经综合征.如果治疗不当,病人的生命可能会受到威胁。因此，早期识别和早期治疗非常重要。
