免疫检查点抑制剂致多重抗神经元抗体阳性自身免疫性脑炎1例

A case of autoimmune encephalitis with multiple anti-neuronal antibodies associated with immune checkpoint inhibitors

自身免疫性脑炎是一类由机体自身免疫机制介导的脑炎,肿瘤和感染是较明确的诱发因素。免疫检查点抑制剂引起的自身免疫性脑炎鲜有报道,本文报告1例我院收治的病例,以提高临床医师对该病的认识。患者为49岁男性,因肺癌应用Durvalumab治疗,用药3个周期后出现记忆力减退,癫痫,直至昏迷。脑脊液抗NMDAR抗体、抗GABABR抗体阳性。经丙种球蛋白联合甲泼尼龙免疫治疗,患者神志逐渐转清,可遵嘱完成简单动作。后患者于2021年5月22日去世。

Autoimmune encephalitis is a kind of encephalitis mediated by the autoimmune mechanism,tumors and infections are common triggering factors.But autoimmune encephalitis caused by immune checkpoint inhibitors is rarely reported.We herein reported this rare case to attract the attention of clinicians.The patient was a 49-year-old male with small cell lung cancer who presented with memory loss,seizures and coma after treatment with 3 cycles of Durvalumab.Cerebrospinal fluid test results revealed anti-NMDAR antibody and anti-GABABR antibody were both positive.After treatment with methylprednisolone and intravenous immunogloblin,his consciousness recovered and he could follow simple instructions.However,the patient died of lung cancer at 2021-05-22.