Immune Checkpoint Inhibitor-Associated Transverse Myelitis

Abstract

Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer and are increasingly used. Thus, awareness of various complications in the form of immunity-related adverse events is increasing. Transverse myelitis following ICIs is a rare but severe neurological adverse event, and information about this entity is minimal. ICI-associated transverse myelitis should be considered a rapid and comprehensive differential diagnosis after evaluating infective, metabolic, or other inflammatory-autoimmune pathologies. After diagnosis, early immunomodulation is required through intravenous high-dose methylprednisolone, IVIg, or plasmapheresis. It should be kept in mind that different etiologies may coexist or a superimposed condition may cause each other, and concurrent treatment should not be delayed. Further studies are needed to investigate the neurological manifestations that may develop in association with these therapies further and help establish guidelines for their management. In this case report, a rare case of ICI-associated transverse myelitis in a 62-year-old male patient was presented.

Keywords

• Immune checkpoint inhibitor
• adverse event
• transverse myelitis

İmmün Kontrol Noktası İnhibitörü ile İlişkili Transvers Miyelit

Abstract

İmmün kontrol noktası inhibitörleri (immune checkpoint inhibitors, ICIs) kanser tedavisinde oldukça etkilidir ve giderek daha fazla kullanılmaktadır. Bu nedenle, bağışıklıkla ilişkili advers olaylar şeklinde çeşitli komplikasyonlara ilişkin farkındalık artmaktadır. ICI'ları takiben gelişen transvers miyelit, nadir ancak ciddi bir nörolojik advers olaydır ve bu antite hakkındaki bilgiler çok sınırlıdır. Enfektif, metabolik veya diğer enflamatuar-otoimmün patolojilerin değerlendirilmesinden sonra hızlı ve kapsamlı bir ayırıcı tanı olarak ICI kaynaklı transvers miyelit dikkatle düşünülmelidir. Tanıdan sonra, intravenöz yüksek doz metilprednizolon, IVIg veya plazmaferez şeklinde erken immünomodülasyon gereklidir. Farklı etiyolojilerin bir arada bulunabileceği veya üst üste binen bir durumun birbirine neden olabileceği akılda tutulmalı ve eş zamanlı tedavi geciktirilmemelidir. Bu tedavilere bağlı olarak gelişebilecek nörolojik bulguların daha fazla araştırılması ve bunların yönetimine ilişkin kılavuzların oluşturulmasına yardımcı olmak için daha fazla çalışmaya ihtiyaç vardır. Bu olgu sunumunda, 62 yaşında bir erkek hastada, nadir görülen bir ICI ile ilişkili transvers miyelit vakası sunulmuştur.

Keywords

• İmmun kontrol noktası inhibitörü
• advers olay
• transvers miyelit

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