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01.12.2018 | Case report | Ausgabe 1/2018 Open Access

BMC Cancer 1/2018

Neuromyelitis optica spectrum disorder secondary to treatment with anti-PD-1 antibody nivolumab: the first report

BMC Cancer > Ausgabe 1/2018
Yoshitsugu Narumi, Ryohei Yoshida, Yoshinori Minami, Yasushi Yamamoto, Shiori Takeguchi, Kohei Kano, Kae Takahashi, Tsukasa Saito, Jun Sawada, Hiroya Terui, Takayuki Katayama, Takaaki Sasaki, Yoshinobu Ohsaki



Immune checkpoint blockade is developed as standard treatment for non-small cell lung cancer. However immune-related adverse events (irAE) have still unknown complications. Here, we report a patient with lung squamous cell carcinoma who developed neuromyelitis optica spectrum disorder with nivolumab.

Case presentation

A 75-year-old Japanese man with lung squamous cell carcinoma was administered nivolumab as second-line treatment. Two months after treatment with nivolumab, he presented acute paralysis in the bilateral lower limbs, sensory loss. Spinal magnetic resonance imaging showed T2 hyperintense lesions between C5-6 and Th12-L1. He was diagnosed with neuromyelitis optica spectrum disorder (NMOSD) by anti-aquaporin-4 antibody-positive in the serum and other examinations. After treatment, steroid reactivity was poor.


This is the first patient who developed anti-AQP4 antibody-positive NMOSD as a nivolumab-induced irAE. Clinicians should be aware of this kind of potential neurological complication by using immune check point inhibitor and start the treatment of this irAE as soon as possible.
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