2023 Volume 116 Issue 12 Pages 1217-1223
Immune checkpoint inhibitors (ICIs) have been approved for the treatment of recurrent/metastatic head and neck cancer, expanding the range of treatment strategies. On the other hand, immune-related adverse events (irAEs) are known to occur with ICI therapy, and a small number of adverse events related to the nervous system are also known. We report a case of encephalitis and pneumonia caused by ICIs in a patient with nasopharyngeal cancer.
A 79-year-old man developed fever, impaired consciousness, and myoclonus after pembrolizumab therapy for nasopharyngeal cancer. After comprehensive examination, he was diagnosed as having pembrolizumab-induced autoimmune encephalitis and pneumonia and started on treatment with prednisolone (120 mg/day). The symptoms improved transiently with the treatment, but recurred when the dose of prednisolone was gradually reduced to 15 mg/day. The dose of prednisolone was therefore increased again to 60 mg/day and tapered, and finally, it was possible to prevent relapse at a maintenance dose of 20 mg/day.
The frequency of irAEs is expected to increase due to the expanded indications of ICIs, and in patients with suspected irAEs, appropriate diagnosis and management through comprehensive multidisciplinary consultation are important.
