Symptoms of nervous system damage in a patient undergoing anti-PD1 immunotherapy

Abstract

Symptoms of nervous system damage during immunotherapy with anti-PD1 antibodies occur in approximately 6% of patients. The most commonly reported neurological adverse reactions are Guillain-Barre syndrome, polyneuropathy, demyelinating diseases, myasthenia gravis, and encephalitis. In the presented patient with disseminated skin melanoma, after four administrations of nivolumab, paraesthesia hindering walking and weakness of the lower limbs appeared. Based on Doppler ultrasound, venous thrombosis was excluded. Computed tomography of the head did not show metastases or signs of intracranial ischaemia or bleeding. The patient was consulted neurologically several times. Steroid therapy, gabapentin, duloxetine, and painkillers were used. Despite the temporary improvement due to implemented treatment, the patient died. No definitive diagnosis could be made, but the symptoms suggest Guillain-Barre syndrome.