Autopsy and Case Reports
Autopsy and Case Reports
Clinical Case Report and Review

Atezolizumab-induced encephalitis in a patient with metastatic breast cancer: a case report and review of neurological adverse events associated with checkpoint inhibitors

Rita Nader; Esther Tannoury; Tamina Rizk; Hady Ghanem

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ABSTRACT: Immune-mediated encephalitis as an adverse event due to checkpoint inhibitors is very rare. We describe herein the case of a 38-year-old woman with metastatic triple-negative breast cancer who developed seizures and somnolence twelve days after receiving the first dose of Atezolizumab. Work up ruled out all infectious etiologies, and the patient was eventually diagnosed with immune-mediated meningoencephalitis. Symptoms recovered with a high-dose of steroids, and she was found to have an excellent response on follow-up imaging, which raised the question of whether a relationship exists between the occurrence, and severity of the adverse event and the response to treatment. Only a few other cases of atezolizumab–related encephalitis have been published. Early recognition and treatment are crucial; the reason why we are describing this case along with a review of the literature and a review on all the neurological immune-related adverse events due to the different checkpoint inhibitors.


Atezolizumab, Immunotherapy, Encephalitis, Breast Neoplasms, Neurology


1 U.S. Food & Drug Administration – FDA. FDA approves first treatment for rare form of skin cancer. Spring, MD: FDA; 2017 [cited 2019 Oct 10]. Available from:

2 Schmid P, Adams S, Rugo HS, et al. Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer. N Engl J Med. 2018;379(22):2108-21. PMid:30345906.

3 Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12(4):252-64. PMid:22437870.

4 Trinh S, Le A, Gowani S, La-Beck NM. Management of immune-related adverse events associated with immune checkpoint inhibitor therapy: a minireview of current clinical guidelines. Asia Pac J Oncol Nurs. 2019;6(2):154-60. PMid:30931360.

5 Larkin J, Chmielowski B, Lao CD, et al. Neurologic serious adverse events associated with nivolumab plus ipilimumab or nivolumab alone in advanced melanoma, including a case series of encephalitis. Oncologist. 2017;22(6):709-18. PMid:28495807.

6 Laserna A, Tummala S, Patel N, El Hamouda DEM, Gutiérrez C. Atezolizumab-related encephalitis in the intensive care unit: case report and review of the literature. SAGE Open Med Case Rep. 2018;6:6. PMid:30116528.

7 Arakawa M, Yamazaki M, Toda Y, et al. Atezolizumab-induced encephalitis in metastatic lung cancer: a case report and literature review. eNeurologicalSci. 2018;14:49-50. PMid:30619952.

8 Levine JJ, Somer RA, Hosoya H, Squillante C. Atezolizumab-induced Encephalitis in Metastatic Bladder Cancer: A Case Report and Review of the Literature. Clin Genitourin Cancer. 2017;15(5):e847-9. PMid:28372981.

9 Kim A, Keam B, Cheun H, Lee S-T, Gook HS, Han M-K. Immune-Checkpoint-Inhibitor-Induced Severe Autoimmune Encephalitis Treated by Steroid and Intravenous Immunoglobulin. J Clin Neurol. 2019;15(2):259-61. PMid:30877699.

10 Dalakas MC. Neurological complications of immune checkpoint inhibitors: what happens when you ‘take the brakes off’ the immune system. Ther Adv Neurol Disorder. 2018;11:175628641879986.

11 Spain L, Tippu Z, Larkin JM, Carr A, Turajlic S. How we treat neurological toxicity from immune checkpoint inhibitors. ESMO Open. 2019;4(Suppl 4):e000540.

12 Makarious D, Horwood K, Coward J. Myasthenia gravis: an emerging toxicity of immune checkpoint inhibitors. Eur J Cancer. 2017;82:128-36. PMid:28666240.

13 Feng S, Coward J, Mccaffrey E, Coucher J, Kalokerinos P, O’Byrne K. Pembrolizumab-induced encephalopathy: a review of neurological toxicities with immune checkpoint inhibitors. J Thorac Oncol. 2017;12(11):1626-35. PMid:28843363.

14 Becquart O, Lacotte J, Malissart P, et al. Myasthenia gravis induced by immune checkpoint inhibitors. J Immunother. 2019;42(8):309-12. PMid:31246640.

15 National Comprehensive Cancer Network. Management of immunotherapy related toxicities (Version 2). 2019 [cited 2019 Oct 10]. Available from:

16 Hottinger AF. Neurologic complications of immune checkpoint inhibitors. Curr Opin Neurol. 2016;29(6):806-12. PMid:27653290.

17 Supakornnumporn S, Katirji B. Guillain–Barré Syndrome Triggered by Immune Checkpoint Inhibitors. J Clin Neuromuscul Dis. 2017;19(2):80-3. PMid:29189553.

18 Kyriazoglou A, Liontos M, Papadopoulos C, et al. Guillain-Barré Syndrome related to nivolumab: case report of a patient with urothelial cancer and review of the literature. Clin Genitourin Cancer. 2019;17(2):e360-4. PMid:30612920.

19 Patel AS, Snook RJ, Sehdev A. Chronic inflammatory demyelinating polyradiculoneuropathy secondary to immune checkpoint inhibitors in melanoma patients. Discov Med. 2019;28(152):107-11. PMid:31926582.

20 Astaras C, de Micheli R, Moura B, Hundsberger T, Hottinger AF. Neurological adverse events associated with immune checkpoint inhibitors: diagnosis and management. Curr Neurol Neurosci Rep. 2018;18(1):3. PMid:29392441.

21 Spain L, Walls G, Julve M, et al. Neurotoxicity from immune-checkpoint inhibition in the treatment of melanoma: a single centre experience and review of the literature. Ann Oncol. 2017;28(2):377-85. PMid:28426103.

22 Conry R. Central nervous system toxicities of anti-cancer immune checkpoint blockade. Journal of Neurology and Neuromedicine. 2016;1(4):39-45.

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