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Muscle Nerve. 2017 Dec;56(6):E162-E167. doi: 10.1002/mus.25672. Epub 2017 May 16.

Motor polyradiculopathy during pembrolizumab treatment of metastatic melanoma.

Author information

1
Department of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.
2
Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
3
Medical Oncology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.

Abstract

INTRODUCTION:

Pembrolizumab, a monoclonal antibody directed against the immune checkpoint programmed cell death-1 receptor (PD-1), has improved survival in patients with advanced melanoma. Neuromuscular immune-mediated side effects have been rarely reported.

METHODS:

We describe a 44-year-old man with metastatic melanoma who presented with progressive muscle weakness after 23 doses of pembrolizumab.

RESULTS:

The patient developed asymmetric, proximal muscle weakness and atrophy in all four limbs. Cerebrospinal fluid examination showed albuminocytologic dissociation. MRI revealed contrast enhancement of the lumbosacral roots. Electrodiagnostic studies demonstrated widespread fibrillation potentials in all four limbs, suggesting a generalized motor polyradiculopathy. Despite pembrolizumab discontinuation and treatment with steroids and intravenous immunoglobulin, limb weakness worsened. Electrodiagnostic studies were repeated, and showed marked and diffuse axonal motor damage. Seven weeks after clinical onset the patient was treated with plasma exchanges. He showed no further deterioration.

DISCUSSION:

We report a severe motor polyradiculopathy associated with an anti-PD-1 agent that expands the spectrum of neuromuscular complications of this class of drugs. Muscle Nerve 56: E162-E167, 2017.

KEYWORDS:

anti-programmed death-1 receptor; immune neuropathy; pembrolizumab; polyradiculoneuropathy; toxic neuropathy

PMID:
28439919
DOI:
10.1002/mus.25672
[Indexed for MEDLINE]

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