Nivolumab

Abstract

Posterior reversible leukoencephalopathy syndrome: case report A 66-year-old man developed posterior reversible encephalopathy syndrome (PRES) during treatment with nivolumab for oesophageal squamous cell carcinoma*. The man with oesophageal squamous cell carcinoma, started receiving treatment with nivolumab [route and dosage not stated]. Five days after treatment initiation, he presented due to a fall. On arrival, he was unresponsive, requiring intubation for airway protection. His vitals were significant for a BP of 101/68mm Hg. He was found to be in status epilepticus. Workup included a lumbar puncture with no evidence for infection or paraneoplastic disease, and a normal CT head. An MRI revealed mild restricted diffusion within the left greater than right thalami, with diffuse vasogenic oedema that involved essentially the entire bilateral thalami. There was also diffuse cortical restriction involving the bilateral parietal and occipital lobes, with extensive vasogenic oedema, more striking in the parieto-occipital lobes. Based on the examinations, he was diagnosed with PRES secondary to the nivolumab therapy [duration of treatment to reaction onset not stated]. The man was eventually extubated, and was noted to have decreased wakefulness due to the bilateral thalamic involvement. He was started on levodopa/carbidopa to help aide wakefulness.