Abstract Details

Title When Immunotherapy Strikes the Brain: A Rare Case of Posterior Reversible Encephalopathy Syndrome after Nivolumab and Ipilimumab

Topic Neurohospitalist

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-007

Objective Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by neurotoxic effects such as seizures, impaired vision, and headaches as well as vasogenic edema predominantly seen posteriorly on imaging. The advent of new immunotherapies in cancer patients has brought increased awareness to PRES, and a need for high clinical suspicion to expedite treatment of the underlying risk factors. We present a rare case of PRES following immunotherapy with Nivolumab and Ipilimumab.

Background N/A

Design/Methods N/A

Results We present a rare case of posterior reversible encephalopathy syndrome (PRES) in a 43-year-old man with metastatic melanoma to the brain treated with chemotherapy, radiation, and resection of a left frontal metastasis. He presented with one week of confusion, forgetfulness, and difficulty performing daily activities, accompanied by intermittent, throbbing headaches for a month. His last immunotherapy infusion with nivolumab (Opdivo) and ipilimumab (Yervoy) was three weeks prior. On admission, blood pressure was 154/97 mmHg. Neurological exam showed mild dysarthria, right facial droop, and hyperreflexia in the right leg. MRI demonstrated vasogenic edema involving the parietal, temporal, and cerebellar regions bilaterally, consistent with PRES. EEG revealed diffuse slowing without seizure activity. Immunotherapy was promptly discontinued, and blood pressure was stabilized with labetalol. His cognition and neurological function returned to baseline within one week. He was discharged home in stable condition and referred to oncology to discuss alternative treatment options. This case highlights the importance of recognizing PRES as a reversible but serious complication of immune checkpoint inhibitors.

Conclusions As immunotherapeutic treatments continue to evolve, the incidence of PRES is expected to rise. Early recognition and prompt management of underlying risk factors are essential, as timely intervention can render this potentially serious syndrome largely reversible, preserving a favorable prognosis.

Authors/Disclosures
Adrian J. Diaz, DO (Memorial Healthcare System) PRESENTER	Dr. Diaz has nothing to disclose.
Sadia Waheed, MBBS	Dr. Waheed has nothing to disclose.
Taylor Alfonso, DO	Dr. Alfonso has nothing to disclose.
Andrea M. Siguenza	Miss Siguenza has nothing to disclose.
Emaan Fawad, Other	Miss Fawad has nothing to disclose.
Fajar Fawad, Other	Miss Fawad has nothing to disclose.
Mohammed Qureshi, MD	Dr. Qureshi has nothing to disclose.
Fawad Yousuf, MBBS	Dr. Yousuf has nothing to disclose.

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