Occurrence of Autoimmune Encephalitis in a Patient with Hepatocellular Carcinoma after Atezolizumab and Bevacizumab Combination Therapy: A Case Study

Abstract

This is a case of a 68-year-old man who sought consultation with a local physician due to pain in his right back. He was referred to our hospital and a liver mass was found. The diagnosis of hepatocellular carcinoma was established with multiple lymph nodes and bone metastases. Thereafter, Atezolizumab/bevacizumab combination therapy (ATZ+BV) was initiated. On the 16th day, after the start of the therapy, he developed impaired consciousness of JCS 10. Blood ammonia level and head magnetic resonance imaging showed no abnormalities; however, cerebrospinal fluid examination showed a minimal increase in cell number and protein cell dissociation. Autoimmune encephalitis was then suspected. On the same day, he was started on steroidal pulse therapy. His consciousness remarkably improved, and the patient was discharged on the 39th hospital day without sequelae. On follow-up, no relapse of encephalitis was noted, and lenvatinib was introduced as a second-line treatment on the 60th day after the start of ATZ+BV, which is still ongoing.