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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Bibliographic Details
Published inCase reports in medicine Vol. 2017; no. 2017; pp. 1 - 4
Main Authors Amano, Masahiro, Shiomi, Kazutaka, Mochida, Kosuke, Mochizuki, Hitoshi, Sakai, Katsuya, Nakazato, Masamitsu
Format Journal Article
LanguageEnglish
Published Cairo, Egypt Hindawi Publishing Corporation 01.01.2017
Hindawi
John Wiley & Sons, Inc
Hindawi Limited
Wiley
Subjects
Analysis
Antigens
Biopsy
Case Report
Case reports
Diagnosis
Dosage and administration
Drug therapy
Enzymes
Family medical history
Guillain-Barre syndrome
Immune checkpoint inhibitors
Immunotherapy
Intravenous administration
Kinases
Liver
Lung cancer
Magnetic resonance imaging
Medicine
Melanoma
Metastases
Metastasis
Methylprednisolone
Monoclonal antibodies
Mononeuritis multiplex
Muscle strength
Nerve conduction
Neuralgia
Oncology
Patients
Peripheral nervous system
Prednisolone
Rhabdomyolysis
Skin cancer
Targeted cancer therapy
Thyroid gland
Japan
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Summary: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.
Bibliography:Academic Editor: Thomas R. Chauncey
ISSN:1687-9627
1687-9635
DOI:10.1155/2017/1093858