Abstract Details

Title Case Report: Checkpoint Inhibitor Associated Autoimmune Encephalitis

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 086

Objective To describe a case of checkpoint inhibitor associated autoimmune encephalitis.

Background Pembrolizumab, an immune checkpoint inhibitor, is increasingly being used in the treatment of various malignancies with significant improvement in patient survival. Autoimmune encephalitis is a rare and underreported neurological complication of immunotherapy.

Design/Methods N/A

Results A 44-year-old female with a past medical history of melanoma presented with a three-month history of worsening confusion and generalized weakness four months after completing 17 cycles of adjuvant immunotherapy with Pembrolizumab over the span of one year. Examination on presentation revealed altered mental status with inability to follow commands. MRI of the brain and spine were unremarkable, and EEG showed generalized slowing. Extensive autoimmune, infectious and metabolic workup, including CSF studies, were negative, and there was no evidence of tumor recurrence. Encephalitis was suspected and empiric therapy with IV methylprednisolone and then IV immunoglobulin and thiamine were provided, with little clinical improvement. Consideration was given for checkpoint inhibitor associated autoimmune encephalitis and oncology expertise was requested. The patient was transferred to a quaternary center where she was treated with plasmapheresis, IV methylprednisolone, and IV immunoglobulin with improvement in her mental status and independent functional abilities. She continued on oral steroids with taper and on mycophenolate mofetil for ongoing immune suppression upon discharge to a skilled nursing facility.

Conclusions This case represents a challenging diagnosis of autoimmune encephalitis associated with checkpoint inhibitor therapy. The recognition of autoimmune encephalitis as a rare potential complication of checkpoint inhibitors is crucial given that immunotherapy continues to become more prevalent in the treatment of malignancy.

Authors/Disclosures
Lynette M. Fisher PRESENTER	Miss Fisher has nothing to disclose.
Madison Starcher, MD (West Virginia University)	No disclosure on file
Suzanne Crandall, DO (Charleston Area Medical Center)	Dr. Crandall has nothing to disclose.
Darshan A. Dave, MD (Neurology & Headache Clinic)	Dr. Dave has nothing to disclose.

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