Case ReportOpen Access

Carpal Tunnel Syndrome as an Unusual Immune Checkpoint Inhibitor Adverse Effect: A Case Series and Review of the Literature

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DOI: 10.23958/ijirms/vol05-i11/981· Pages: 550 - 553· Vol. 5, No. 11, (2020)· Published: November 23, 2020
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Abstract

While immune checkpoint inhibitors (ICIs) have transformed standards of care and drastically improved patient prognoses in several malignant diseases, a range of immune related adverse events (irAEs) from ICIs have been observed. This case series describes the clinical course of three patients with unusual immune checkpoint-inhibitor (ICI) induced toxicities. These three patients developed carpal tunnel syndrome (CTS) while on ICI therapy. The first patient was a 79 year-old male who received neo-adjuvant chemo-immunotherapy and adjuvant immunotherapy (atezolizumab) for stage II-B lung adenocarcinoma, the second patient was a 70 year-old female who received immunotherapy only (nivolumab) for stage IV renal cell carcinoma and the third patient was a 71 year-old male who received adjuvant immunotherapy (nivolumab) for stage 2-A melanoma. The patients developed carpal tunnel syndrome with severe neuropathy as a result of therapy. All patients had complete symptomatic relief when treated with either corticosteroids or intravenous immunoglobulins for CTS.

Keywords

Atezolizumab – Nivolumab – Carpal tunnel syndrome – Lung Carcinoma - Renal Cell Carcinoma – Immune Checkpoint
Author details
Walid Shalata
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
✉ Corresponding Author
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Alexander Yakobson
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
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Ismaell Massalha
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
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Roxana D. Grinberg
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
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Iris M. Goldstein
Department of Neurology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Rachel Gibbs
Medical School for International Health and Sciences, Ben-Gurion University, Beer Sheva, Israel.
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Roy Grinberg
Department of Plastic Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Ala Eddin Neime
Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Ali Abu-Juma'a
Department of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Waleed Kian
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
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Nir Peled
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
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Keren Rouvinov
The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, Beer-Sheva, Israel.
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