Atezolizumab
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Autoimmune meningitis: case report. A 56-year-old man developed autoimmune meningitis during treatment with atezolizumab for adenocarcinoma of the lung. The man was an ex-smoker and diagnosed with stage IIIB (p-T4N0M0) adenocarcinoma of the lung. He had underwent radical right middle lobectomy in the past. After 3 years of the surgery, he had a recurrence in the right adrenal gland, which was completely resolved by first line platinum-based chemotherapy. However, after 2 years, examinations revealed a bulky mass in the right retroperitoneal lymph node, multiple metastatic lesions in the left supraclavicular lymph node and right kidney metastases. He was treated with cisplatin and pemetrexed but had insufficient effect. Subsequently, he was treated with gefitinib, osimertinib and nivolumab. However, he showed brain metastases and metastatic lesions in both lungs and lymph nodes. Therefore, he started receiving atezolizumab 12000 mg [route not stated] as a seventh line treatment. After 11 days of atezolizumab initiation, he developed headache, general fatigue and high fever. Despite unspecified non-steroidal analgesic treatment, his symptoms did not improve. Therefore, he was admitted for dysarthria. Head MRI scan revealed meningeal enhancement. A cerebrospinal fluid (CSF) evaluation revealed elevated WBC count and protein concentration 134 mg/dL. On the basis of clinical presentation, he was diagnosed with atezolizumab-induced autoimmune meningitis. The man received treatment with methylprednisolone. On the following day, his neurological state improved. He was started on gradual tapering prednisolone treatment for over 12 weeks. After 1 week of prednisolone treatment, CSF analysis showed improvement. Subsequently, he recovered to baseline conditions. On 29th day of admission, he was discharged. Atezolizumab was discontinued. His condition remained stable without relapse of neurological symptoms for 3 months. Ogawa K, et al. Early-onset meningitis associated with atezolizumab treatment for non-small cell lung cancer: case report and literature review. Investigational New Drugs 38: 803515759 1901-1905, No. 6, 12 May 2020. Available from: URL: http://doi.org/10.1007/s10637-020-00947-w
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Reactions 21 Nov 2020 No. 1831
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