Neuronal intermediate filament paraneoplastic autoimmunity complicating avelumab therapy of Merkel cell carcinoma

Alessandro Dinoto, Andrew McKeon, Gaetano Vattemi, Sara Carta, Sergio Ferrari, Sara Mariotto

Research output: Contribution to journalArticlepeer-review

Abstract

A 67-years-old woman developed subacute oculomotor nerve palsy and cerebellar gait instability while receiving avelumab as immunotherapy for Merkel cell carcinoma. Brain MRI revealed oculomotor nerve T2/FLAIR hyperintensity and contrast enhancement, CSF cell number and protein concentration were slightly increased. Antibodies against intracellular and surface antigens were excluded through commercial assays, but home-made immunohistochemistry on rat brain sections showed a “neurofilament-like” pattern. Antibodies against neuronal intermediate filament (NIF-IgG) were thus tested and resulted positive in both serum and CSF, confirming the diagnosis of NIF-IgG autoimmunity. Avelumab was discontinued and treatment with steroids and intravenous immunoglobulins led to partial improvement.

Original languageEnglish (US)
Article number577882
JournalJournal of neuroimmunology
Volume368
DOIs
StatePublished - Jul 15 2022

Keywords

  • Avelumab
  • Immune checkpoint inhibitors
  • Immune-related adverse events
  • Neuronal intermediate filament
  • Paraneoplastic neurological syndromes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Neurology
  • Clinical Neurology

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