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Case Reports
. 2024 Sep 17;16(9):e69575.
doi: 10.7759/cureus.69575. eCollection 2024 Sep.

Nivolumab-Induced Neuromyopathy: A Case Report

Tal Sharon  1 , Angela Rosenberg  2 , Ekrem Yetiskul  2 , Zaid Khamis  2 , Suzanne El Sayegh  3
Affiliations
Case Reports

Nivolumab-Induced Neuromyopathy: A Case Report

Tal Sharon et al. Cureus. .

Abstract

Nivolumab is an immune checkpoint inhibitor (ICI) that treats various malignancies. Although ICIs have proven efficacious, they can also have detrimental side effects. We present a case of nivolumab-induced quadriparesis mimicking Guillain-Barré syndrome in a patient with stage III squamous cell carcinoma (SCC) of the pharynx with a chronic tracheostomy, who presented after being found unconscious at home. He later developed acute kidney failure, requiring dialysis, and bilateral weakness of his upper and lower extremities. The patient was treated with corticosteroids and intravenous immunoglobulin (IVIG) with minimal improvement. Nivolumab-induced quadriparesis is very threatening and can be fatal if inappropriately managed. Therefore, we strongly advocate for a multidisciplinary team and early corticosteroid prescription to monitor patients on nivolumab therapy to prevent adverse clinical outcomes.

Keywords: immune checkpoint inhibitor; neuromyopathy; nivolumab; oncology; squamous cell carcinoma of the head and neck.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. ECG demonstrating ST segment depression in inferolateral leads, low-voltage QRS complexes, and a short PR interval
The ECG shows ST segment depression in the inferolateral leads (II, III, aVF, V4, V5, and V6). Additionally, the QRS complexes exhibit reduced amplitude across all leads, suggesting a low-voltage pattern. A short PR interval (100-120 msec) is also observed. ECG: electrocardiogram
Figure 2
Figure 2. Coronal section obtained from CT of the patient's cervical spine demonstrates new compression fracture deformity of the C7 vertebral body (arrow)
CT: computed tomography
See this image and copyright information in PMC

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