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Vasculitis del Sistema Nervioso Central Relacionada con Pembrolizumab que se Presenta con Accidentes
Fumiaki Henmi1, Yoshifumi Ogasawara2, Yoshikazu Uesaka1
1Neurology, Toranomon Hospital, Tokyo, JPN.
Cureus
|December 22, 2025
Resumen
Los inhibidores del punto de control inmunitario (ICI) pueden causar eventos adversos raros relacionados con el sistema inmunitario (irAE), como vasculitis cerebral que conduce a accidentes cerebrovasculares isquémicos recurrentes. Considere rápidamente los irAE e inicie corticosteroides junto con la interrupción del ICI para un manejo eficaz.
Área de la Ciencia:
- Neurología
- Oncología
- Inmunología
Sus antecedentes:
- Los inhibidores del punto de control inmunitario (ICI) se asocian con eventos adversos relacionados con el sistema inmunitario (irAE).
- Las complicaciones cerebrovasculares son irAE raras pero graves.
- Los pacientes con cáncer de pulmón no microcítico que reciben ICI están en riesgo.
Objetivo del estudio:
- Informar un caso de infartos cerebrales recurrentes secundarios a eventos adversos relacionados con el sistema inmunitario.
- Destacar el potencial de la vasculitis cerebral como un irAE.
- Enfatizar la importancia de considerar los irAE en pacientes con eventos cerebrovasculares durante la terapia con ICI.
Principales métodos:
- Informe de caso de un paciente varón de 52 años tratado con pembrolizumab para cáncer de pulmón no microcítico.
- Evaluación clínica y radiológica que incluye imágenes vasculares.
- Tratamiento con terapia antiplaquetaria, seguido de la interrupción del pembrolizumab y la iniciación de corticosteroides.
Principales resultados:
- El paciente desarrolló múltiples infartos cerebrales y estenosis arteriales intracraneales multifocales.
- Se produjeron accidentes cerebrovasculares isquémicos recurrentes a pesar de la terapia antiplaquetaria.
- La interrupción del pembrolizumab y la terapia con corticosteroides condujo a la regresión de las estenosis y la interrupción de los infartos.
Conclusiones:
- La vasculitis cerebral es un irAE potencial de los ICI, que se presenta como infartos cerebrales recurrentes.
- La monoterapia antitrombótica puede ser insuficiente; la interrupción temprana del ICI y la iniciación de corticosteroides son cruciales.
- Los médicos deben considerar rápidamente los irAE en pacientes que experimentan eventos cerebrovasculares durante o después de la terapia con ICI.
Palabras clave:
imagen de sangre negraarteriopatía cerebralinfarto cerebralinhibidor del punto de control inmunitario (ICI)evento adverso relacionado con el sistema inmunitario (irAE)cáncer de pulmón no microcíticopembrolizumabaccidente cerebrovascular recurrentevasculitisimagen de la pared del vaso (VWI)
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