ArticleFrontiers in neurology2021
Case Report: Longitudinal Extensive Transverse Myelitis With Novel Autoantibodies Following Two Rounds of Pembrolizumab.
Article in Frontiers in neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Clinical characteristics, management and outcomes in immune checkpoint inhibitor-induced central nervous system demyelinating disease.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Pooled it
- Case Report: Observational use of mycophenolate mofetil in probable steroid-unresponsive immune checkpoint inhibitor-associated transverse myelitis.Frontiers in immunology · 2026Article
- Multidimensional Assessment of Neurological Adverse Reactions Related to PD-1 Inhibitors: A Real-World Pharmacovigilance Study.CNS neuroscience & therapeutics · 2026Article
- Immune checkpoint inhibitors: From friend to foe.Toxicology reports · 2025Article
- Autoimmune GFAP astrocytopathy manifesting as sintilimab-induced myelitis: a Case Report and literature review.Frontiers in immunology · 2025Review
- Evaluation of warning strategies for paraneoplastic neurological syndromes associated with PD-1/PD-L1 inhibitors.Frontiers in immunology · 2025Article
- Toxicity in the era of immune checkpoint inhibitor therapy.Frontiers in immunology · 2024Review
- Neurologic Complications of Cancer Immunotherapy.Current oncology (Toronto, Ont.) · 2023Review
- Review
- Neurology of cancer immunotherapy.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023Review
- Neurological adverse events associated with PD-1/PD-L1 immune checkpoint inhibitors.Frontiers in neuroscience · 2023Review
- Drug-related immune-mediated myelopathies.Frontiers in neurology · 2022Review
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A 63-year-old male with metastatic non-small cell lung cancer developed longitudinal extensive transverse myelitis (LETM) following two cycles of Pembrolizumab, an immune checkpoint inhibitor (ICI) targeting the programmed cell death receptor 1 (PD-1). Magnetic resonance imaging (MRI) showed centromedullary contrast enhancement at several levels, cerebrospinal fluid (CSF) cytology showed lymphocytic pleocytosis, and indirect immunofluorescence assay (IFA) on the primate cerebellum, pancreas, and intestine revealed strong binding of neuronal autoantibodies to unknown antigens. CSF C-X-C motif ligand 13 (CXCL13) was elevated. The patient was treated with plasma exchange (PEX) and intravenous (i.v.) methylprednisolone (MP) 1 g/day for 5 days followed by oral (p.o.) MP 100 mg/day for 10 days with clinical and radiological response. However, after discontinuation of MP, LETM relapsed and the patient developed paralytic ileus presumably due to autoimmune enteropathy and suffered a fatal gastrointestinal sepsis. Findings of novel neuronal autoantibodies and highly elevated CXCL13 in CSF suggest that the severe neurological immune-related adverse event (nirAE) was B-cell mediated contrary to the commonly assumed ICI-induced T-cell toxicity. An individual evaluation of the underlying pathophysiology behind rare nirAEs is essential for choosing treatment regimens and securing optimal outcome.
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