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已发表论文
鳞状非小细胞肺癌序贯免疫检查点抑制剂治疗后出现致命的类固醇难治性自身免疫性脑炎
Authors Huang J, Wang J, Zheng D, Chen J
Received 8 August 2025
Accepted for publication 27 November 2025
Published 4 December 2025 Volume 2025:18 Pages 1329—1336
DOI https://doi.org/10.2147/OTT.S557750
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Lukas Hawinkels
Jianfang Huang,1,* Jian Wang,2,* Dingting Zheng,3 Jianxin Chen4
1Department of Ultrasonography, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China; 2Department of Gastroenterology, Jiaxing Second Hospital, Jiaxing, Zhejiang, 314000, People’s Republic of China; 3The Second People’s Hospital of Quzhou, Quzhou, Zhejiang, 324000, People’s Republic of China; 4Department of International Ward, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jianxin Chen, Department of International Ward, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China, Email cjx8137@163.com
Abstract: Immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC) but can cause severe immune-related adverse events. We report a fatal case of suspected steroid-refractory autoimmune encephalitis in a 71-year-old male with squamous NSCLC, occurring 14 months after sequential ICI therapy (toripalimab, then sintilimab, followed by anlotinib-sintilimab). He presented with acute behavioral decline. Brain MRI revealed non-enhancing T2/FLAIR hyperintensities in the cerebellum and frontal lobes, with low cerebrospinal fluid (CSF) opening pressure. Diagnostic workup was negative for infections and neuronal autoantibodies. Despite aggressive immunosuppression with high-dose corticosteroids, mycophenolate mofetil, and intravenous immunoglobulin, his condition progressed to coma with diffuse cerebral edema and hydrocephalus, leading to death within 14 days. This case highlights the lethal potential of ICI-induced encephalitis, the diagnostic challenges of seronegative presentations, and the urgent need for more effective treatment strategies.
Keywords: immune checkpoint inhibitors, autoimmune encephalitis, steroid-refractory, neurotoxicity, NSCLC
1Department of Ultrasonography, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China; 2Department of Gastroenterology, Jiaxing Second Hospital, Jiaxing, Zhejiang, 314000, People’s Republic of China; 3The Second People’s Hospital of Quzhou, Quzhou, Zhejiang, 324000, People’s Republic of China; 4Department of International Ward, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jianxin Chen, Department of International Ward, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People′s Hospital, Quzhou, Zhejiang, 324000, People’s Republic of China, Email cjx8137@163.com
Abstract: Immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC) but can cause severe immune-related adverse events. We report a fatal case of suspected steroid-refractory autoimmune encephalitis in a 71-year-old male with squamous NSCLC, occurring 14 months after sequential ICI therapy (toripalimab, then sintilimab, followed by anlotinib-sintilimab). He presented with acute behavioral decline. Brain MRI revealed non-enhancing T2/FLAIR hyperintensities in the cerebellum and frontal lobes, with low cerebrospinal fluid (CSF) opening pressure. Diagnostic workup was negative for infections and neuronal autoantibodies. Despite aggressive immunosuppression with high-dose corticosteroids, mycophenolate mofetil, and intravenous immunoglobulin, his condition progressed to coma with diffuse cerebral edema and hydrocephalus, leading to death within 14 days. This case highlights the lethal potential of ICI-induced encephalitis, the diagnostic challenges of seronegative presentations, and the urgent need for more effective treatment strategies.
Keywords: immune checkpoint inhibitors, autoimmune encephalitis, steroid-refractory, neurotoxicity, NSCLC