064  Imilimumab/nivolumab induced paraspinal myositis causing dysphagia. Issue 6 (27th May 2022)

• Record Type: Journal Article
• Authors: Warner, Graham
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 6(2022)
• Page Start: A32
• Page End: A32
• Publication Date: 2022-05-27
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-ABN.101
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Immune checkpoint inhibitors have transformed metastatic melanoma treatment. Imilimumab/Nivolumab combination increases progression-free survival [1], but Imilimumab can cause immune-related condi- tions including hepatitis, colitis and dermatitis[2]. We present a case of Imilimumab/Nivolumab-induced posterior paraspinal muscles myositis. A 78 year-old man with metastatic melanoma with hepatic, osseous, and lymph node spread had 3 weeks of dysphagia to solids but not liquids, 2 months after his last cycle of immunotherapy. He complained of hoarse voice, weight loss, unsteadiness and falls. Examination revealed symmetrical, normal palatal rise without tongue wasting or fasciculation. Speech was hypernasal with poor pharyngeal phonation. There was no fatigue nor ptosis nor extra-ocular motor weakness. Small muscle hand wasting was modest in keeping with general cachexia. Power in all limbs was preserved with no fasciculation. CK was mildly elevated at 522 u/l. Brain MRI showed a normal brain stem with scant cerebral white matter ischaemia. Neck imaging showed no pharyngeal infiltration but extensive muscular oedema involving trapezii and para-spinal muscles (skull base to sacrum), consistent with myositis secondary to immunotherapy. He received 13 days Methylprednisolone 2mg/kg and speech and swallow improved markedly on serial SALT assessments. Inflammatory myopathy is recognised with novel metastatic melanoma treatments, others reporting dysphagia[3] or limb-girdle weakness[4]. Our case highlights the evolving recognition of immunotherapy side effects and awareness for myositis in these patients. [e-mail]