TY - JOUR
T1 - Neuronal intermediate filament paraneoplastic autoimmunity complicating avelumab therapy of Merkel cell carcinoma
AU - Dinoto, Alessandro
AU - McKeon, Andrew
AU - Vattemi, Gaetano
AU - Carta, Sara
AU - Ferrari, Sergio
AU - Mariotto, Sara
N1 - Funding Information:
No funds, grants, or other support was received.
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/7/15
Y1 - 2022/7/15
N2 - 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.
AB - 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.
KW - Avelumab
KW - Immune checkpoint inhibitors
KW - Immune-related adverse events
KW - Neuronal intermediate filament
KW - Paraneoplastic neurological syndromes
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U2 - 10.1016/j.jneuroim.2022.577882
DO - 10.1016/j.jneuroim.2022.577882
M3 - Article
C2 - 35580403
AN - SCOPUS:85130110796
SN - 0165-5728
VL - 368
JO - Advances in Neuroimmunology
JF - Advances in Neuroimmunology
M1 - 577882
ER -