Objective: We reported a case that cerebellar ataxia and decreased accumulation of right cerebellum at SPECT appeared after immunotherapy using immune-checkpoint inhibitor “Pembrolizumab” for Non-small cell lung cancer.

Background: Immune-checkpoint inhibitors (ICis) is a new immunotherapy for malignant tumor , and it is getting increasingly important that neurologist understand about neuromuscular disorders as immune-releted adverse events (irAE) . Neuromuscular irAE causes various neurological disorders that including peripheral neuropathy ,myopathy, and encephalitis etc. But there is few reports of cerebellar ataxia cased by ICis.

Method: About the case that we experienced ,we compared examination findings, clinical course, and medical treatment between our case and past reports. Our case was a 71 years old female presented to us with diplopia and dysarthria that appeared after immunotherapy using Pembrolizumab for Non-small cell lung cancer stage Ⅳ. Her neurological findings were diplopia, dysarthria, nystagmus, and right coordination disturbance. SPECT demonstrated the decreased accumulation of right cerebellum. We denied collagen disease, autoimmune disease, neurodegenerative disease, malignant lymphoma, and paraneoplastic neurological syndrome (PNS), and so we diagnosed her as having irAE caused by Pembrolizumab. We conducted immunosuppressive therapy including adenocortical steroid pulse therapy and IVIg therapy, but she didn’t improve diplopia, nystagmus compaired with improvement of right coordination disturbance.

Results: Our case had unprecedented significance in terms of function morphological abnormalities compaired with other cases.

Conclusion: We reported a case of cerebellar ataxia caused by Pembrolizumab for Non-small cell lung cancer. Immunosuppressive therapy didn’t improve neurological findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-cerebellar-ataxia-caused-by-pembrolizumab-for-non-small-cell-lung-cancer/