Abstract
Introduction: Malignant melanoma poses a significant threat due to its aggressiveness and high fatality rates. Recent advances in immunotherapy and targeted molecular therapies have transformed the treatment landscape for advanced melanoma, improving overall survival. However, the rising use of immune checkpoint inhibitors (ICIs) introduces complexities, particularly in neurological immune-related adverse events (irAEs), necessitating careful consideration and multidisciplinary management. Case Report: We report the case of a 77-year-old woman with stage IV cutaneous melanoma, which was hospitalized with polyneuropathy following immunotherapy treatment with ipilimumab and nivolumab combination. The complex presentation involved considerations of COVID-19 vaccination, detection of Epstein–Barr virus (EBV) in cerebrospinal fluid, and the challenge of distinguishing infectious from immune-related causes. The multidisciplinary team navigated multiple diagnostic uncertainties. The patient’s clinical evolution, including complications and treatment responses, provided insights into managing severe neurological irAEs associated with immunotherapy. Conclusion: Neurologic immune-related (IR) toxicity is well established, and it may led to severe adverse events, which are complex to diagnose and manage. This case report highlights the challenges and difficulties found, with relevant confounding factors, which arise the relevance of the need of a multidisciplinary team to deal with neurologic immune-related toxicities.
Published Version
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