Nivolumab-induced sensory ganglionopathy

Nivolumab is s a human monoclonal antibody. Due to its widespread use in many cancers, including Merkel cell carcinoma, adverse reactions associated with nivolumab, such as neuropathies, endocrinopathies, gastrointestinal problems, and skin toxicities have been increasing. Sensory ganlionopathy is rarely observed in these patients.

We present a 63-year-old male with a medical history of Merkel cell carcinoma that recurred two times in the inguinal region. After undergoing surgery with adjuvant radiotherapy, a second surgery was performed. The patient suffered from tingling in all four limbs plus difficulty in walking after initiation of the third dose of nivolumab.

After 1 month of 1 mg/kg/day methylprednisolone treatment, he showed significant improvement. Subsequently, the systemic corticosteroid regimen was tapered to 5 mg every other day. The treatment resulted in significant improvement in all extremities.

Sensory ganlionopathy can be seen as a side effect of an immune checkpoint inhibitor, even though it is very extraordinary. This is the case in the literature to develop sensory ganlionopathy due to nivolumab. We believe that patients using nivolumab may develop sensory ganlionopathy and management should be taken on this point.