Rituximab in Refractory Myositis and Acute Neuropathy Secondary to Checkpoint Inhibitor Therapy.

Area of Science:

• Oncology
• Immunology
• Neurology

Background:

• Immune checkpoint inhibitors (ICIs) represent a significant advancement in cancer therapy.
• Increasing ICI use has revealed a spectrum of immune-related adverse events affecting multiple organ systems, including the nervous system.
• Management of ICI-induced neurological complications can be challenging, especially in steroid-refractory cases.

Observation:

• An 85-year-old male treated with nivolumab and ipilimumab developed severe neurological symptoms including diplopia, ptosis, dysphagia, and generalized weakness.
• Diagnostic workup revealed refractory myositis, acute neuropathy, and autoimmune thyroiditis, with negative acetylcholine receptor and MuSK antibodies.
• The patient's condition did not improve with standard treatments such as steroids, intravenous immunoglobulins (IVIG), and plasmapheresis (PLEX).

Findings:

• This case highlights refractory autoimmune myositis and neuropathy secondary to ICI therapy.
• The patient experienced significant symptom improvement after initiating rituximab treatment.
• Neurological complications from ICIs can be diverse and may require alternative immunosuppressive strategies beyond first-line therapies.

Implications:

• Awareness of ICI-induced neurological complications is crucial for timely diagnosis and management.
• Rituximab demonstrates potential efficacy in managing severe, refractory ICI-associated autoimmune neurological disorders.
• Further research is needed to establish formal guidelines for managing ICI-induced neurological toxicities.