Nivolumab induced immune mediated transverse myelitis in a patient with metastatic melanoma: The broad clinical spectrum of immune mediated neurologic disorders

Immune checkpoint inhibitors (ICPi) represent a novel group of monoclonal antibodies targeting different cellu-lar surface molecules such as programmed cell death protein 1 (PD-1), programmed cell death protein 1 ligand (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Inhibition of these receptors triggers further lymphocytic activation which exerts its effect by enabling tumor cell recognition and subsequent attack. ICPis have become a standard of care in daily Clinical Oncology and have proven to be effective in a wide variety of neoplasms. Nevertheless, since ICPi treatment may trigger an enhanced immune response, in susceptible individ-uals it may lead to autoinflammatory diseases known as Immune Related Adverse Events (IRAEs). In this sense, ICPis have opened a new and varied spectrum of oncologic treatment derived toxicity that carries a broad variety of clinical scenarios that range from mild to life-threatening inflammatory complications. We hereby present the case of an elderly woman who presented with an immune mediated transverse myelitis which accounts for a rare IRAE. In this sense, this case remarks the challenging nature of IRAEs and their potential severity. Hence the necessity of clinicians to closely evaluate subtle clinical scenarios in the setting of immunotherapy to identify potentially severe IRAEs as well as to be aware of the broad diagnostic spectrum of IRAEs so as to reach an accurate diagnosis and set an early therapeutic intervention.

Automated summary

Immune checkpoint inhibitors have become a standard of care in oncology, but their use can lead to immune-related adverse events. Clinicians must closely monitor and intervene early to identify and manage these potentially severe complications.