Title : PD-1 inhibitor-induced refractory Acute Inflammatory Demyelinating Polyneuropathy (AIDP): Case report
Abstract:
Immune checkpoint inhibitors have marked a new era in contemporary cancer therapy. However, they are associated with a spectrum of immune-related adverse events (irAEs), including rare but severe neurologic toxicities (nirARs). Here, we report a case of acute inflammatory demyelinating polyneuropathy (AIDP) which developed following neoadjuvant pembrolizumab for triple negative breast cancer. The patient experienced progressive ascending weakness, autonomic dysfunction, and ultimately respiratory failure requiring mechanical ventilation. Despite recognition and prompt treatment with immunosuppressive therapies, the patient’s course was complicated by progression of neurologic symptoms and paralysis necessitating tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement. This case highlights a rare but life-threatening neurologic toxicity of immune checkpoint inhibitors and demonstrates the importance of multidisciplinary management, careful neurologic monitoring, and the degree of ambiguity regarding long-term neurologic recovery from nirARs. It also highlights the need for the development of models that can identify which patients may be at highest risk of developing serious (grade 3 or greater) immune-related adverse events from immune checkpoint inhibitor therapies.
