Immune Checkpoint Inhibitor-Related Dysautonomia in Merkel Cell Carcinoma: A Case Report.

Area of Science:

• Oncology
• Immunology
• Neurology

Background:

• Immune checkpoint inhibitors (ICIs) are therapies targeting cancer by modulating T-cell activation.
• Immune-related adverse events (irAEs) are known toxicities of ICIs, affecting various systems.
• ICI-related dysautonomia is a rare but significant irAE with undefined management.

Purpose of the Study:

• To report a case of ICI-related dysautonomia in a patient with Merkel cell carcinoma.
• To describe the clinical presentation, management, and outcome of this rare toxicity.
• To review existing literature on ICI-induced dysautonomia.

Main Methods:

• Case report of a 57-year-old male patient treated with neoadjuvant nivolumab.
• Detailed description of the patient's ICI-related dysautonomia symptoms (orthostatic hypotension, urinary retention, hearing loss, diplopia) and concurrent hepatitis.
• Literature review on ICI-induced dysautonomia.

Main Results:

• The patient developed significant ICI-related dysautonomia and hepatitis.
• Treatment with intravenous immunoglobulin (IVIG) resulted in marked clinical improvement of dysautonomia.
• ICI-induced dysautonomia presents with diverse manifestations.

Conclusions:

• ICI-related dysautonomia is a rare and challenging irAE.
• Early identification and prompt treatment, such as with IVIG, are crucial for patient recovery.
• Understanding the broad spectrum of irAEs is essential for managing patients on ICI therapy.