免疫疗法诱导的谷氨酸脱羧酶65性脑炎
Immunotherapy-Induced Glutamic Acid Decarboxylase 65 Cerebellitis.
摘要(中文译文)
免疫检查点抑制剂（ICIs）是晚期癌症的重要治疗手段。然而，由于其作用机制，它们存在继发免疫相关不良事件（irAEs）的风险。ICI药物通过抑制抑制免疫细胞的检查点发挥作用，这些检查点的存在是为了防止自身免疫，而ICI药物使这些细胞致敏以攻击和消灭癌症。尽管ICIs已显著改善晚期癌症患者的预后，但部分患者会因这种自身免疫状态而出现不良反应。一种较少见但可能危及生命的毒性反应是小脑炎。我们报告一例接受多塔利单抗治疗的子宫癌肉瘤患者发生抗谷氨酸脱羧酶65（anti-GAD 65）相关ICI小脑炎的病例。该患者表现为非特异性症状，包括乏力以及令人担忧的共济失调症状。完整神经系统评估显示其血清和脑脊液（CSF）中均存在抗GAD 65抗体。她无法开始门诊治疗，遂入院接受静脉类固醇和静脉注射免疫球蛋白（IVIG）治疗，随后症状改善。她接受了长期逐渐减量的类固醇方案并定期输注IVIG。其免疫治疗已停止。本病例报告强调了临床早期怀疑ICI相关神经毒性和快速启动治疗的重要性。及时识别和早期干预对于尽量减少长期残疾至关重要。
Abstract
Immune checkpoint inhibitors (ICIs) are an important treatment modality for advanced cancer. However, they carry the risk of immune-related adverse events (irAEs) secondary to their mechanism of action. ICI medications function by inhibiting the checkpoints that suppress immune cells, which exist to prevent autoimmunity, and prime these cells to attack and eliminate cancer. While ICIs have substantially improved the prognosis for patients with advanced cancer, some patients experience adverse effects from this autoimmune state. One less common, but potentially life-threatening toxicity is cerebellitis. We present a case of anti-glutamic acid decarboxylase 65 (anti-GAD 65) related ICI cerebellitis in a patient with uterine carcinosarcoma on dostarlimab. This patient presented with nonspecific symptoms, including fatigue and a concerning symptom of ataxia. Full neurological evaluation demonstrated anti-GAD 65 antibodies in both her serum and cerebrospinal fluid (CSF). She was unable to start outpatient treatment and was admitted for intravenous steroids and intravenous immunoglobulin (IVIG) with subsequent improvement in her symptoms. She was placed on a prolonged steroid taper with regular IVIG infusions. Her immunotherapy was discontinued. This case report highlights the importance of early clinical suspicion of ICI-related neurotoxicities and rapid treatment initiation. Prompt recognition and early intervention are important to minimize long-term disability.
如何引用
AMA
Alysse Jensen, Hardik Thakkar, Scott Kramer, Jacqueline Young. Immunotherapy-Induced Glutamic Acid Decarboxylase 65 Cerebellitis.. Cureus. 2026; doi:10.7759/cureus.109334.
APA
Alysse Jensen, Hardik Thakkar, Scott Kramer, Jacqueline Young (2026). Immunotherapy-Induced Glutamic Acid Decarboxylase 65 Cerebellitis.. Cureus. https://doi.org/10.7759/cureus.109334
GB/T 7714
Alysse Jensen, Hardik Thakkar, Scott Kramer, Jacqueline Young. Immunotherapy-Induced Glutamic Acid Decarboxylase 65 Cerebellitis.[J]. Cureus, 2026 doi:10.7759/cureus.109334.
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