We describe a patient of Hodgkin’s lymphoma who developed acute onset neurological symptoms due to nivolumab that responded to infliximab.

Immune checkpoint inhibitors are promising in the treatment of a variety of tumors. Nivolumab is a monoclonal antibody to programmed cell death-1 (PD-1) protein. It acts as an immune checkpoint inhibitor by disrupting the interaction of the PD-1 receptor with its ligands. Usage of such immune check point inhibitors is associated with an array of unique autoimmune-related adverse events (irAEs). Neurological irAEs associated with nivolumab are typically treated steroid or IVIG. Infliximab is used to treat gastrointestinal irAEs.

A 42 year old male with relapsed Hodgkin's lymphoma treated with Nivolumab 2 weeks prior was hospitalized with acute onset right facial weakness, dysarthria, and urinary retention. Neurological examination revealed right upper and lower facial weakness, tongue fasciculation, diffuse, symmetric proximal more than distal lower extremity weakness, lower extremity areflexia, and ataxia. MRI spine with contrast showed enhancement of lumbosacral nerve roots. MRI brain was normal. CSF analysis showed lymphocytic pleocytosis and elevated protein. Infectious work-up was negative. Electrodiagnostic evaluation demonstrated findings suggestive of chronic sensorimotor polyneuropathy with predominant demyelinating features. He was treated with IV immunoglobulin and high dose steroids with no clinical improvement. Further treatment with Infliximab resulted in rapid resolution of his neurological deficits.