A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis
We report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on se...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2017/1093858 |
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| author | Katsuya Sakai Hitoshi Mochizuki Kosuke Mochida Kazutaka Shiomi Masahiro Amano Masamitsu Nakazato |
| author_facet | Katsuya Sakai Hitoshi Mochizuki Kosuke Mochida Kazutaka Shiomi Masahiro Amano Masamitsu Nakazato |
| author_sort | Katsuya Sakai |
| collection | DOAJ |
| description | We report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on serologic examination, muscle biopsy, magnetic resonance imaging of the limbs, and a nerve conduction study. A course of intravenous methylprednisolone (mPSL) was initiated at 1 g/day for 3 days. After that, oral prednisolone (PSL) was started at 1 mg/kg/day and gradually tapered. Limb muscle strength improved, but when PSL was reduced to 0.3 mg/kg/day, the weakness recurred, and a nerve conduction study showed exacerbation of mononeuropathy multiplex. The patient was again administered intravenous mPSL (0.5 g/day for 3 days) followed by oral PSL at 0.5 mg/kg/day, and his neurological symptoms improved. Nivolumab, an immune checkpoint inhibitor, is used for the treatment of advanced melanoma and other cancers and causes various immune-related adverse events (irAEs). However, neurological irAEs related to nivolumab are rare. Furthermore, there are no reports of simultaneous nerve and muscle impairment. Unexpected irAEs affecting various organs should be recognized and treated appropriately. |
| format | Article |
| id | doaj-art-7a81142379c2479e9b5b719c1ae03252 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-7a81142379c2479e9b5b719c1ae032522025-02-03T06:08:27ZengWileyCase Reports in Medicine1687-96271687-96352017-01-01201710.1155/2017/10938581093858A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and RhabdomyolysisKatsuya Sakai0Hitoshi Mochizuki1Kosuke Mochida2Kazutaka Shiomi3Masahiro Amano4Masamitsu Nakazato5Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Miyazaki, JapanDivision of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Miyazaki, JapanDepartment of Dermatology, University of Miyazaki, Miyazaki, JapanDivision of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Miyazaki, JapanDepartment of Dermatology, University of Miyazaki, Miyazaki, JapanDivision of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Miyazaki, JapanWe report an 81-year-old man with multiple liver metastases after tumorectomy for primary mediastinal malignant melanoma, who experienced limb weakness and sensory disturbance after nivolumab monotherapy. He was diagnosed with nivolumab-induced mononeuropathy multiplex and rhabdomyolysis based on serologic examination, muscle biopsy, magnetic resonance imaging of the limbs, and a nerve conduction study. A course of intravenous methylprednisolone (mPSL) was initiated at 1 g/day for 3 days. After that, oral prednisolone (PSL) was started at 1 mg/kg/day and gradually tapered. Limb muscle strength improved, but when PSL was reduced to 0.3 mg/kg/day, the weakness recurred, and a nerve conduction study showed exacerbation of mononeuropathy multiplex. The patient was again administered intravenous mPSL (0.5 g/day for 3 days) followed by oral PSL at 0.5 mg/kg/day, and his neurological symptoms improved. Nivolumab, an immune checkpoint inhibitor, is used for the treatment of advanced melanoma and other cancers and causes various immune-related adverse events (irAEs). However, neurological irAEs related to nivolumab are rare. Furthermore, there are no reports of simultaneous nerve and muscle impairment. Unexpected irAEs affecting various organs should be recognized and treated appropriately.http://dx.doi.org/10.1155/2017/1093858 |
| spellingShingle | Katsuya Sakai Hitoshi Mochizuki Kosuke Mochida Kazutaka Shiomi Masahiro Amano Masamitsu Nakazato A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis Case Reports in Medicine |
| title | A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis |
| title_full | A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis |
| title_fullStr | A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis |
| title_full_unstemmed | A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis |
| title_short | A Case of Nivolumab-Induced Severe Mononeuropathy Multiplex and Rhabdomyolysis |
| title_sort | case of nivolumab induced severe mononeuropathy multiplex and rhabdomyolysis |
| url | http://dx.doi.org/10.1155/2017/1093858 |
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