Pembrolizumab

Abstract

Various toxicities: case report A 62-year-old woman developed inflammatory dermatitis, acute kidney injury (AKI)/acute interstitial nephritis (AIN) and posterior reversible encephalopathy syndrome (PRES) following treatment with pembrolizumab for metastatic melanoma. The woman, who had metastatic melanoma, received five cycles of pembrolizumab administered 3 weekly [route and dose not stated]. Following the fifth pembrolizumab cycle, she presented with a loss of consciousness event. The event was preceded by flashing lightning in her vision and she was confused afterwards consistent with seizure activity arising from the occipital lobe. She reported that she had been experiencing bifrontal headaches, memory impairment and intermittent vision change described as blurriness since last one month. She was hospitalised. Anamnesis revealed that she had previously experienced grade 2 inflammatory dermatitis and AKI/AIN which had been considered as complications of pembrolizumab therapy. These complications had been treated and managed by prednisolone. Upon admission, cerebral MRI revealed predominantly cortical, symmetric FLAIR and T2 hyperintensity in the occipital lobe, parietal and posterior frontal lobes bilaterally. Her blood pressure was 161/93mm Hg. An EEG revealed bilateral cortical dysfunction, with no epileptiform discharges. She was diagnosed with PRES secondary to pembrolizumab [time to reaction onsets not clearly stated]. The woman was treated with methylprednisolone and levetiracetam. Pembrolizumab was discontinued. Thereafter, clinical improvement was noted. A repeat MRI demonstrated resolution of previously described changes. Upon follow-up, no recurrence of symptoms was noted.