Case Report: Pseudomeningeosis and Demyelinating Metastasis-Like Lesions From Checkpoint Inhibitor Therapy in Malignant Melanoma

Case Report: Pseudomeningeosis and Demyelinating Metastasis-Like Lesions From Checkpoint Inhibitor Therapy in Malignant Melanoma

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Immune checkpoint inhibitors (ICIs) have considerably expanded the effective treatment options for malignant melanoma.ICIs revert tumor-associated immunosuppression and potentiate T-cell mediated tumor clearance.Immune-related neurologic adverse events (irNAEs) manifest in the central (CNS) or peripheral nervous system (PNS) and most frequently present as encephalitis or myasthenia gravis respectively.

We report on a 47-year old male patient with metastatic melanoma who developed signs of cerebellar disease five weeks after the start of ICI Ball - Miscellaneous treatment (ipilimumab and nivolumab).Magnetic resonance imaging (MRI) of the brain and spine revealed multiple new contrast enhancements suggestive of parenchymal and leptomeningeal metastasis.Cerebral spinal fluid (CSF) evaluation showed a lymphomononuclear pleocytosis in the absence of tumor cells.

Subsequent stereotactic brain biopsy confirmed demyelinating disease.High-dose corticosteroid treatment resulted in immediate improvement of the Drink clinical symptoms.MRI scans and CSF re-evaluation were conducted six weeks later and showed a near-complete remission.

The strong resemblance to neoplastic CNS dissemination and irNAEs is a particularly difficult diagnostic challenge.Treating physicians should be aware of irNAEs as those can be effectively treated with high-dose steroids.