Atezolizumab-induced encephalitis in a patient with metastatic breast cancer: a case report and review of neurological adverse events associated with checkpoint inhibitors

Nader, Rita; Tannoury, Esther; Rizk, Tamina; Ghanem, Hady

doi:10.4322/acr.2021.261

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…Several case reports have featured encephalitis as a CNS neurotoxicity. 11 Similar to our case, two patients with cerebellar ataxia associated with atezolizumab have been described. In addition, three patients who developed encephalitis after atezolizumab treatment had diffuse leptomeningeal involvement on MRI, as in our case, and resolution we observed after steroid therapy 11,[14][15][16]20 (Table 1).…”

Section: Discussionsupporting

confidence: 86%

“…The clinical benefits of ICIs have resulted in their increased use, which in turn has led to an increase in related irAEs. 9 Rare side effects, such as encephalitis, [10][11][12][13][14] cerebellar ataxia, 15,16 aseptic meningitis, 17 posterior reversible encephalopathy syndrome, 18 opsoclonus, and myoclonus 19 have been reported with atezolizumab-induced central nervous system (CNS) involvement. Several case reports have featured encephalitis as a CNS neurotoxicity.…”

Section: Discussionmentioning

confidence: 99%

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Atezolizumab-induced cerebellar ataxia in a patient with metastatic small cell lung cancer: A case report and literature review

Kapağan

Aksu

Yüzkan

et al. 2023

J Oncol Pharm Pract

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Introduction The use of immune checkpoint inhibitors (ICIs), which have an important role in the treatment of malignant tumors, is increasing. Although rarely observed, neurological immune-related adverse events (irAEs) associated with ICIs result in high morbidity and mortality. Small cell lung cancer (SCLC) is a common cause of neurological paraneoplastic syndromes (PNSs). The differentiation between PNSs and neurological irAEs is important in patients using ICIs. Cerebellar ataxia caused by atezolizumab is a rare irAE. Case report In this context, we present a 66-year-old man with SCLC who developed immune-mediated cerebellar ataxia after three cycles of atezolizumab, a programmed cell death ligand-1 inhibitor. The admission brain and spinal gadolinium-based contrast-enhanced magnetic resonance imaging (MRI) supported the preliminary diagnosis and indicated leptomeningeal involvement. However, the blood tests and a lumbar puncture did not reveal any structural, biochemical, paraneoplastic, or infectious cause. Management and outcome of high-dose steroid treatment resulted in an improvement in the radiological involvement, as evidenced both clinically and on follow-up whole spine MRI. Therefore, the immunotherapy was discontinued. The patient was discharged on day 20 without neurological sequelae. Discussion In light of this, we present this case to emphasize the differential diagnosis of neurological irAEs originating from ICIs, which require rapid diagnosis and treatment, and clinically similar PNSs and radiologically similar leptomeningeal involvement, in the case of SCLC.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Atezolizumab-induced cerebellar ataxia in a patient with metastatic small cell lung cancer: A case report and literature review

Kapağan

Aksu

Yüzkan

et al. 2023

J Oncol Pharm Pract

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“…Encephalitis caused by atezolizumab has only been recorded in a few cases as an irAE. To the best of our knowledge, only 9 cases have been reported (7)(8)(9)(10)(11)(12)(13)(14)(15). The main information for these cases is shown in Table I.…”

Section: Discussionmentioning

confidence: 99%

“…Encephalitis is estimated to occur in 0.1-0.2% of patients treated with ICIs (6). To the best of our knowledge, atezolizumab-associated encephalitis has been reported in bladder cancer, cervical cancer, lung cancer, hepatocellular carcinoma and breast cancer (7)(8)(9)(10)(11)(12)(13)(14)(15). It is clinically characterized by seizures, confusion, altered behavior, headaches and alterations of consciousness (16).…”

Section: Introductionmentioning

confidence: 99%

Atezolizumab‑associated encephalitis in metastatic breast cancer: A case report

et al. 2022

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Immune checkpoint inhibitors have been critical in the treatment of advanced malignancies in recent years. Encephalitis caused by atezolizumab is an uncommon immune-related adverse event. The case of a 65-year-old female diagnosed with encephalitis closely associated with atezolizumab medication for metastatic advanced breast cancer is presented in the current study. Following a fourth atezolizumab dose 10 days previously, the patient fell into a deep coma. Initial brain magnetic resonance imaging revealed multiple patchy T2 hyperintensities in the bilateral cerebellar hemisphere, vermis of the cerebellum, bilateral frontal lobe, temporal lobe, parietal lobe and occipital cortex. Meanwhile, there were aberrant signs on diffusion-weighted imaging. The diagnosis of atezolizumab-induced encephalitis seemed probable after ruling out other possible causes of encephalitis. Subsequently, the condition of the patient worsened and there were indications of cardiac and respiratory arrest. Chest compressions were provided immediately, as well as a balloon mask for assisted ventilation, a medication boost, stimulated breathing and other symptomatic therapy. The patient's vital signs temporarily stabilised after this series of rescue measures. The patient refused further therapy and insisted on being discharged, and died a few days after being discharged from the hospital. In this case, the patient's encephalitis symptoms associated with atezolizumab were not as typical as previously documented. The patient's condition swiftly deteriorated to heartbeat apnea, and steroid pulse therapy was not received in a timely manner, resulting in an unfavourable outcome.

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“…Despite extensive eforts from medical professionals and researchers, a defnitive method for treating breast cancer has yet to be established and reliable evidence for its prevention remains elusive [8][9][10][11]. Some components of breast cancer tissues are highly malignant and pose a severe danger to patients' lives as they can spread to other vital organs [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Efficient Breast Cancer Diagnosis from Complex Mammographic Images Using Deep Convolutional Neural Network

Bukht

Ahmad²,

Almadhor

et al. 2023

Computational Intelligence and Neuroscience

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Medical image analysis places a significant focus on breast cancer, which poses a significant threat to women’s health and contributes to many fatalities. An early and precise diagnosis of breast cancer through digital mammograms can significantly improve the accuracy of disease detection. Computer-aided diagnosis (CAD) systems must analyze the medical imagery and perform detection, segmentation, and classification processes to assist radiologists with accurately detecting breast lesions. However, early-stage mammography cancer detection is certainly difficult. The deep convolutional neural network has demonstrated exceptional results and is considered a highly effective tool in the field. This study proposes a computational framework for diagnosing breast cancer using a ResNet-50 convolutional neural network to classify mammogram images. To train and classify the INbreast dataset into benign or malignant categories, the framework utilizes transfer learning from the pretrained ResNet-50 CNN on ImageNet. The results revealed that the proposed framework achieved an outstanding classification accuracy of 93%, surpassing other models trained on the same dataset. This novel approach facilitates early diagnosis and classification of malignant and benign breast cancer, potentially saving lives and resources. These outcomes highlight that deep convolutional neural network algorithms can be trained to achieve highly accurate results in various mammograms, along with the capacity to enhance medical tools by reducing the error rate in screening mammograms.

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Atezolizumab-induced encephalitis in a patient with metastatic breast cancer: a case report and review of neurological adverse events associated with checkpoint inhibitors

Abstract: How to cite: Nader R, Tannoury E, Rizk T, Ghanem H. Atezolizumab-induced encephalitis in a patient with metastatic breast cancer: a case report and review of neurological adverse events associated with checkpoint inhibitors. Autops Case Rep [Internet]. 2021;11:e2021261.

Cited by 10 publications

References 20 publications

Atezolizumab-induced cerebellar ataxia in a patient with metastatic small cell lung cancer: A case report and literature review

Atezolizumab-induced cerebellar ataxia in a patient with metastatic small cell lung cancer: A case report and literature review

Atezolizumab‑associated encephalitis in metastatic breast cancer: A case report

Efficient Breast Cancer Diagnosis from Complex Mammographic Images Using Deep Convolutional Neural Network

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