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Case Reports: Unusual association of diseases/symptoms
Pembrolizumab-induced acute right L5 neuritis unresponsive to steroids
  1. Lachlan Fitzpatrick1,
  2. Zarnie Lwin2,3 and
  3. Christian Gericke4,5
  1. 1Internal Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
  2. 2Medical Oncology, The Prince Charles Hospital, Brisbane, Queensland, Australia
  3. 3Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  4. 4The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
  5. 5Neurology, The Prince Charles Hospital, Brisbane, Queensland, Australia
  1. Correspondence to Dr Lachlan Fitzpatrick; lachlan.fitzpatrick{at}health.qld.gov.au

Abstract

We present a case of a patient with metastatic lung adenocarcinoma who developed severe right lower limb radicular pain in a L5-S1 dermatomal distribution 5 months into treatment with carboplatin, pemetrexed and pembrolizumab. MRI of the lumbar spine demonstrated contrast enhancement of the right L5 nerve root consistent with neuritis. The patient was treated with intravenous methylprednisolone 2 mg/kg/day for 3 days, followed by oral prednisolone 1 mg/kg/day with a slow wean over 6 weeks. There was no improvement and their performance status deteriorated to an Eastern Cooperative Oncology Group (ECOG) score of 3, representing capability of only limited self-care. We commenced induction therapy with intravenous immunoglobulin 2 g/kg over 5 days, which resulted in complete resolution of pain sustained for 3 weeks before recurrence of symptoms. We continued maintenance therapy with intravenous immunoglobulin 0.4 g/kg over 2 days at 4–5 weekly intervals, which led to resolution of symptoms and ECOG score to 1.

  • Neurooncology
  • Peripheral nerve disease
  • Lung cancer (oncology)
  • Unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2022-250971

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    Footnotes

    • Contributors LF performed the literature review and case report write-up with significant contributions to the completed case report by both ZL and CG who were directly involved in the patient’s care.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.