尼沃卢马布治疗患者的脑炎和免疫相关并发症:一个病例报告
Georgios Lyras1, Prokopios Karydis1, Sofia Dionysia Tetradi2
1Department of Internal Medicine, University Hospital of Patras, Patras, Greece, pgnp.gr.
Case reports in medicine
|January 1, 2026
概括
免疫检查点抑制剂 (ICI) 可以引起与免疫相关的不良反应 (irAEs). 这一案例突显了ICI诱导的脑炎和其他irrAEs在患有转移性细胞癌的患者中,成功地用皮质类固醇和rituximab治疗.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 神经学 神经学
背景情况:
- 像尼沃卢马布这样的免疫检查点抑制剂 (ICI) 已推进了癌症治疗,但可能导致与免疫相关的不良反应 (irAEs).
- irAEs可以在各种器官中表现出来,需要高度的临床怀疑才能及时诊断和管理.
- 转移性细胞癌 (mRCC) 是一种恶性瘤,在这种瘤中使用ICI,增加了irAEs的可能性.
研究的目的:
- 报告一个患有mRCC的患者患上ICI诱导脑炎和其他irAEs的病例.
- 讨论ICI诱导的神经和系统性IRAE的诊断挑战和治疗策略.
- 强调通过及时干预恢复的潜力.
主要方法:
- 一名55岁的mRCC患者接受了尼沃卢马布和卡博桑提尼布治疗,出现了混乱和低血压.
- 诊断工作包括脑部MRI,揭示了新的T2 / FLAIR高强度病变,导致ICI诱导脑炎的假设.
- 治疗包括皮质类固醇,IVIG和rituximab,并监测其他irrAEs,如低血炎,甲状腺炎和血液溶解性贫血.
主要成果:
- 患者经历了混乱,迷失方向和低血压,归因于ICI诱导的脑炎和二次上腺功能不充分.
- 大脑MRI显示了多个新的T2/FLAIR高强度病变.
- 用皮质类固醇和IVIG治疗导致快速改善,在Rituximab管理后神经症状几乎完全缓解. 同时发现过渡性自身免疫性甲状腺炎和自身免疫性溶血性贫血也被注意到.
结论:
- ICI诱导脑炎是一种罕见但可能危及生命的irrAE,可以发生在基于nivolumab的治疗中.
- 及时诊断和用皮质类固醇,IVIG和潜在的rituximab治疗可以导致显著的恢复.
- 这一案例凸显了在接受ICI治疗的患者中识别各种irAEs的重要性,包括神经和内分泌并发症.
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