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A case of severe encephalitis while on PD-1 immunotherapy for recurrent clear cell ovarian cancer

机译：PD-1免疫疗法治疗复发性透明细胞卵巢癌的严重脑炎病例

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Recurrent clear cell ovarian carcinoma is a difficult to treat condition and early trial data has suggested a possible role for immune checkpoint inhibitors. Nivolumab is an anti-PD-1 immunotherapy that has been used in this setting. While immune related toxicity of these agents has been well described, the occurrence of immune specific neurotoxicity is thought to be rare. We present a case of severe encephalitis while on PD-1 immunotherapy for a recurrent ovarian clear cell cancer and we believe this to be the first such reported case associated with the use of PD-1 inhibitor monotherapy. In this case, a 64-year-old woman with persistent clear cell ovarian cancer on Nivolumab presented with a severe fever of unknown origin and delirium; initial imaging and diagnostic work-up suggested a neurological etiology, but with no clear source. We concluded that this was a severe case of immune related encephalitis, thought to be brought about by the anti-PD-1 immunotherapy which responded well to systemic corticosteroids and plasmapheresis and the patient able to make a full recovery. We present a summary of the case and its management as well as a review of the literature on the previously reported neurotoxicity's of PD-1 inhibitors. Highlights ? Immune related encephalitis thought to be produced by an anti-PD-1 immunotherapy. ? Systemic corticosteroids, plasmapheresis, patient able to make a full recovery. ? Review of literature on the previously reported neurotoxicity's of PD-1 inhibitors.
机译：复发性透明细胞卵巢癌是难以治疗的疾病，早期的试验数据表明免疫检查点抑制剂可能具有作用。 Nivolumab是一种抗PD-1免疫疗法，已在这种情况下使用。尽管已经很好地描述了这些试剂的免疫相关毒性，但认为免疫特异性神经毒性的发生很少。我们介绍了PD-1免疫疗法治疗复发性卵巢透明细胞癌时发生的重度脑炎病例，我们相信这是与PD-1抑制剂单一疗法相关的首例此类报道病例。在这种情况下，一名在Nivolumab上患有持续性透明细胞卵巢癌的64岁女性出现了来历不明和and妄的严重发热;最初的影像学检查和诊断检查提示神经系统病因，但尚无明确来源。我们得出的结论是，这是一例严重的免疫相关性脑炎，被认为是由抗PD-1免疫疗法引起的，对全身性皮质类固醇和血浆置换反应良好，患者能够完全康复。我们提供了该病例及其治疗的总结，以及有关先前报道的PD-1抑制剂神经毒性文献的综述。强调 ？免疫相关性脑炎被认为是由抗PD-1免疫疗法产生的。 ？全身性皮质类固醇，血浆置换术使患者能够完全康复。 ？关于先前报道的PD-1抑制剂的神经毒性的文献综述。

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