SHM Converge Scientific Abstract ePoster Gallery-Immune-Related Adverse Events: A Hidden Blessing?

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A 74-year-old man with hepatitis C cirrhosis and hepatocellular carcinoma was started on atezolizumab plus bevacizumab, the standard first-line treatment for unresectable or metastatic disease. After two cycles, he developed worsening mental status. Brain MRI showed bilateral periventricular white matter T2/FLAIR hyperintensities consistent with treatment-associated encephalopathy. Cerebrospinal fluid studies were negative for infection and carcinomatosis, supporting a diagnosis of immune-related encephalitis/encephalopathy, which is a rare but potentially life-threatening immune checkpoint inhibitor complication and often a diagnosis of exclusion.<br /><br />Both cancer therapy agents were stopped, and the patient was treated with high-dose prednisone followed by a gradual taper over four months. Three months later, his mental status improved and the encephalitis resolved. Interestingly, during follow-up his cancer appeared to respond well, with decreased tumor burden, normalized alpha-fetoprotein, and no new liver mass.<br /><br />The report highlights that immunotherapy can cause severe neurologic toxicities that must be recognized promptly. Management may include drug discontinuation, corticosteroids, IVIG, plasmapheresis, or other immunosuppressive agents depending on severity. It also notes that immune-related adverse events may sometimes correlate with improved tumor response and survival, suggesting a possible “hidden blessing” despite the risks.

Asset Subtitle

Navin Bhatt

Meta Tag

Author List Maryam Hajiabbasi, Mohamedtaki Tejani, Nagma Shah, Navin Bhatt, Shristi Nepal

Category Clinical Vignettes

Concept Immune-Related Adverse Event

Concept Immunotherapy

Concept Encephalitis

Concept Encephalopathy

Concept Atezolizumab

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai / Elmhurst

Presenting Author Navin Bhatt

Track Adult

Keywords

hepatocellular carcinoma

hepatitis C cirrhosis

atezolizumab

bevacizumab

immune-related encephalitis

immune checkpoint inhibitor

treatment-associated encephalopathy

brain MRI

high-dose prednisone

corticosteroid taper

Immune-Related Adverse Event

Immunotherapy

Encephalitis

Encephalopathy

Atezolizumab