Skip to main content

Advertisement

SpringerLink
Log in

Severe Acute Orthopnea: Ipilimumab-Induced Bilateral Phrenic Nerve Neuropathy

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Ipilimumab is a monoclonal antibody used in the treatment of unresectable or metastatic melanoma. Several immune-related adverse events including potential fatal events have been reported following its use. We report a case of a 66-year-old man who presented with severe acute exertional dyspnea and orthopnea following administration of ipilimumab for metastatic melanoma. Although various peripheral neuropathy syndromes associated with ipilimumab have been reported, bilateral phrenic nerve paralysis has not been previously reported. This case also highlights the clinical features of bilateral phrenic nerve neuropathy. Pulmonologists have to be aware of these unusual immune-related respiratory adverse events in patients being treated with monoclonal antibodies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Product Information: YERVOY(R) IV solution, ipilimumab IV solution. Bristol-Myers Squibb Company, Princeton, 2011

  2. Peggs KS, Quezada SA, Korman AJ et al (2006) Principles and use of anti-CTLA4 antibody in human cancer immunotherapy. Curr Opin Immunol 18:206–213

    Article  CAS  PubMed  Google Scholar 

  3. Wolchok JD, Neyns B, Linette G et al (2010) Ipilimumab monotherapy in patients with pretreated advanced melanoma: a randomised, double-blind, multicentre, phase 2, dose-ranging study. Lancet Oncol 11:155–164

    Article  CAS  PubMed  Google Scholar 

  4. Wilgenhof S, Neyns B (2011) Anti-CTLA-4 antibody-induced Guillain-Barré syndrome in a melanoma patient. Ann Oncol 22:991–993

    Article  CAS  PubMed  Google Scholar 

  5. Manousakis G, Koch J, Sommerville RB et al (2013) Multifocal radiculoneuropathy during ipilimumab treatment of melanoma. Muscle Nerve 48(3):440–444

    Article  CAS  PubMed  Google Scholar 

  6. Voskens CJ, Goldinger SM, Loquai C et al (2013) The price of tumor control: an analysis of rare side effects of anti-CTLA-4 therapy in metastatic melanoma from the ipilimumab network. PLoS One. 8(1):e53745

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Maur M, Tomasello C, Frassoldati A et al (2012) Posterior reversible encephalopathy syndrome during ipilimumab therapy for malignant melanoma. J Clin Oncol. 30(6):e76–e78. doi:10.1200/JCO.2011.38.7886

    Article  CAS  PubMed  Google Scholar 

  8. Johnson DB, Saranga-Perry V, Lavin PJ et al (2014) Myasthenia Gravis induced by ipilimumab in patients with metastatic melanoma. J Clin Oncol. doi:10.1200/JCO.2013.51.1683

  9. Bhatia S, Huber BR, Upton MP et al (2009) Inflammatory enteric neuropathy with severe constipation after ipilimumab treatment for melanoma: a case report. J Immunother 32:203–205

    Article  PubMed  Google Scholar 

  10. Tang EW, Jardine DL, Rodins K et al (2003) Respiratory failure secondary to diabetic neuropathy affecting the phrenic nerve. Diabet Med 20:599–601

    Article  CAS  PubMed  Google Scholar 

  11. Mokhlesi B, Jain M (1999) Pulmonary manifestations of POEMS syndrome: case report and literature review. Chest 115:1740–1742

    Article  CAS  PubMed  Google Scholar 

  12. Robinson LR, Brownsberger R, Raghu G (1998) Respiratory failure and hypoventilation secondary to neurosarcoidosis. Am J Respir Crit Care Med 157:1316–1318

    Article  CAS  PubMed  Google Scholar 

  13. Bansal SK, Haldar N, Dhand UK et al (1991) Phrenic neuropathy in arsenic poisoning. Chest 100:878–880

    Article  CAS  PubMed  Google Scholar 

  14. Avila EK, Goenka A, Fontenla S (2011) Bilateral phrenic nerve dysfunction: a late complication of mantle radiation. J Neurooncol 103:393–395

    Article  PubMed  Google Scholar 

  15. Lahrmann H, Grisold W, Authier FJ et al (1999) Neuralgic amyotrophy with phrenic nerve involvement. Muscle Nerve 22:437–442

    Article  CAS  PubMed  Google Scholar 

  16. Kumar N, Folger WN, Bolton CF (2004) Dyspnea as the predominant manifestation of bilateral phrenic neuropathy. Mayo Clin Proc. 79(12):1563–1565

    Article  PubMed  Google Scholar 

  17. Ahmed R, McNamara S, Gandevia S et al (2012) Paradoxical abdominal wall movement in bilateral diaphragmatic paralysis. Pract Neurol 12:184–186

    Article  PubMed  Google Scholar 

  18. Benditt JO, McCool FD (2010) The respiratory system and neuromuscular diseases. In: Mason RJ, Broaddus VC, Martin TR, King TE Jr, Schraufnagel DE, Murray JF, Nadel JA (eds) Murray and Nadel’s textbook of respiratory medicine, 5th edn. Elsevier Saunders, Philadelphia

    Google Scholar 

  19. Boon AJ, Sekiguchi H, Harper CJ et al (2014) Sensitivity and specificity of diagnostic ultrasound in the diagnosis of phrenic neuropathy. Neurology. 83(14):1264–1270

    Article  PubMed  Google Scholar 

  20. Houston JG, Morris AD, Howie CA et al (1992) Technical report: quantitative assessment of diaphragmatic movement: a reproducible method using ultrasound. Clin Radiol 46:405–407

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, 200 First St. SW, Rochester, MN, 55905, USA

    Praveen Jinnur & Kaiser G. Lim

Authors
  1. Praveen Jinnur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaiser G. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaiser G. Lim.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jinnur, P., Lim, K.G. Severe Acute Orthopnea: Ipilimumab-Induced Bilateral Phrenic Nerve Neuropathy. Lung 193, 611–613 (2015). https://doi.org/10.1007/s00408-015-9716-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-015-9716-8

Keywords

Search

Navigation