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BMJ Case Reports 2016; doi:10.1136/bcr-2016-215012
  • CASE REPORT

Limbic encephalitis following immunotherapy against metastatic malignant melanoma

  1. Ayse Turan1
  1. 1Greater Manchester Neurosciences Centre, Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
  2. 2Pennine Acute Hospitals NHS Trust, Manchester, UK
  1. Correspondence to Dr Sharfaraz Salam, sharfaraz{at}doctors.org.uk
  • Accepted 9 March 2016
  • Published 23 March 2016

Summary

Novel immunotherapies are increasingly being used to treat malignant melanoma. The use of such agents has been associated with triggering autoimmunity. However, there has been a paucity in reports of limbic encephalitis associated with these immunotherapies. Pembrolizumab, a monoclonal antibody against programmed cell death antigen (PD-1), is currently being trialled in the UK to treat malignant melanoma. We report a unique case of antibody-negative limbic encephalitis presenting 1 year after starting pembrolizumab, in the context of malignant melanoma. The patient presented with progressive cognitive decline. MRI of the brain revealed signal change within the limbic structures. Cerebrospinal fluid studies confirmed evidence of inflammation with raised white cell count and protein. We were able to prevent further progression of symptoms by stopping pembrolizumab and treating the patient instead with steroids. We advocate considering autoimmune neuroinflammation as a differential for neurological disorders presenting in patients receiving PD-1 antagonist treatment and immunotherapy in general.

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