PMC8696256_01
Timeline of case report of patient with rare delayed immune-related toxicities. (A) February 14, 2020, first brain metastasis resection. (B) March 2020, first cycle ipilimumab/nivolumab. (C) April 4, second cycle ipilimumab/nivolumab. (D) April 8, second brain metastasis resection. (E) May 12, presentation with immune-related pericarditis. (F) June 24, third brain metastasis resection. (G) July 14, stereotactic radiosurgery of resection cavity. (H) Presentation with auto-immune encephalitis.
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He proceeded with resection of the right parietal lobe metastases in February followed by ipilimumab (3 mg/kg)/nivolumab (1 mg/kg) commencing in March ( Figure 1 ).
Serial MRI brain showing development of encephalitis and serial PET/CT demonstrating the patient's durable response to immunotherapy. (A) MRI brain with gadolinium Sept 2, 2020:no abnormalities in medial temporal region. (B) MRI brain October 29, 2020 shows new T2/FLAIR hyperintensity in the right medial temporal lobes. (C) PET/CT March 2020. (D) PET CT March 2021.
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An MRI brain revealed T2/FLAIR hyperintensity in the right mesotemporal lobe with differentials including encephalitis or postictal changes ( Figure 2 ).