Pembrolizumab related Guillain barre syndrome, a rare presentation in a patient with a history of lupus and bladder cancer

Vikram Sangani; Mytri Pokal; Mamtha Balla; Ganesh Prasad Merugu; Sreedhar Adapa; Srikanth Naramala; Venu Madhav Konala

doi:10.1080/20009666.2021.1903133

Pembrolizumab related Guillain barre syndrome, a rare presentation in a patient with a history of lupus and bladder cancer

J Community Hosp Intern Med Perspect. 2021 May 10;11(3):388-392. doi: 10.1080/20009666.2021.1903133. eCollection 2021.

Authors

Vikram Sangani¹, Mytri Pokal¹, Mamtha Balla², Ganesh Prasad Merugu³, Sreedhar Adapa⁴, Srikanth Naramala⁵, Venu Madhav Konala⁶

Affiliations

¹ Hospitalist, Department of Internal Medicine, Quantum HC, Macon, Georgia.
² Clinical Assistant Professor, Department of Internal Medicine, University of Toledo and Promedica Toledo Hospital, Toledo, USA.
³ Division Chief and Geriatric Fellowship Program Director, Division of Geriatric Medicine, Department of Family Medicine, University of Toledo, Toledo, USA.
⁴ Department of Internal Medicine, Division of Nephrology, Adventist Medical Center, Hanford, USA.
⁵ Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, USA.
⁶ Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, USA.

Abstract

Immune checkpoint inhibitor-related neurotoxicity causing Guillain Barre Syndrome is relatively uncommon. We discussed an 80-year-old patient with known systemic lupus erythematosus who presented with lower extremity weakness, areflexia and then progressed to respiratory muscle and upper extremity weakness after receiving immunotherapy with checkpoint inhibitors for metastatic bladder cancer. With the increasing use of immunotherapy for the management of cancer, awareness of neurological autoimmune side effects is essential. Immune checkpoint inhibitor-mediated GBS can be severe and fatal if not diagnosed promptly. The hospitalists, neurologists, and oncologists should be aware of neurotoxicity related to immune checkpoint inhibitor therapy requiring a multidisciplinary approach to patient care. Prompt initiation of immunosuppressive therapy is required for the management of immune checkpoint inhibitor-related neurotoxicity.

Keywords: Guillain barre syndrome; Keytruda; PD 1 antibody; immune checkpoint inhibitor; neurological complications; pembrolizumab.