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Journal of Cancer Research and Clinical Oncology

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Open Access 07-09-2023 | Adverse Effects of Cancer Therapy | Correspondence

Encephalitis in a patient with hypopharynx cancer treated with immune checkpoint inhibitors and radiotherapy: a case report and review of the literature

Authors: Yan Kang, Hongchao Zhen, Nina Ma, Hong Zhao, Bangwei Cao

Published in: Journal of Cancer Research and Clinical Oncology | Issue 17/2023

Abstract

Hypopharyngeal cancer (HPC) has one of the most unfavorable prognoses among head and neck squamous cell carcinomas. Immunotherapy in combination with chemotherapy, the same as conventional induction chemotherapy, has emerged as a vital part of the induction therapy protocol for HPC. Meanwhile, the incidence of immune-related adverse events is increasing. In this light, we present the first reported case of immune-associated encephalitis in a patient with hypopharyngeal cancer treated with Camrelizumab (a PD-1 inhibitor). After receiving immunotherapy combined with chemotherapy as induction therapy, along with concurrent chemoradiotherapy, the patient presented with symptoms of fatigue, tremors, drowsiness, and an abnormal signal in the right temporal lobe as shown on a brain magnetic resonance imaging (MRI). Despite the minor elevation in protein and IgG index observed in the lumbar puncture, there is no evidence of abnormal autoantibodies or evidence of pathogenic infection. Following a thorough multidisciplinary consultation, the patient is suspected to be afflicted with immune-related autoimmune encephalitis. Intravenous methylprednisolone was prescribed as an empirical treatment at an initial dosage of 120 mg/day for 3 days, followed by steroid tapering. Finally, the patient experienced complete neurologic and radiographic (brain MRI) recovery. This case serves as a critical reminder that encephalitis is a potential diagnosis that should never be overlooked in patients undergoing immunotherapy who present with abnormal signs of the brain. The timely diagnosis and initiation of immunosuppressive therapy are key components of treating ICI-associated encephalitis.

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Title: Encephalitis in a patient with hypopharynx cancer treated with immune checkpoint inhibitors and radiotherapy: a case report and review of the literature
Authors: Yan Kang
Hongchao Zhen
Nina Ma
Hong Zhao
Bangwei Cao
Publication date: 07-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Adverse Effects of Cancer Therapy
Encephalitis
Hypopharyngeal Cancer
Cancer Immunotherapy
Radiotherapy
Autoimmune Encephalitis
Checkpoint Inhibitors
Cranial MRI
Published in: Journal of Cancer Research and Clinical Oncology / Issue 17/2023
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-023-05328-3

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