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Nivolumab is an immune checkpoint inhibitor (ICI) that treats various malignancies. Although ICIs have proven efficacious, they can also have detrimental side effects. We present a case of nivolumab-induced quadriparesis mimicking Guillain-Barré syndrome in a patient with stage III squamous cell carcinoma (SCC) of the pharynx with a chronic tracheostomy, who presented after being found unconscious at home.

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BACKGROUND CRS (cytokine release syndrome) is a massive activation of the inflammatory system characterized by a supra-physiological rate of inflammatory cytokines. The interleukin 6 cytokine plays a central role in CRS. The main clinical sign of CRS is fever, but CRS can lead to multiple organ failure in severe cases.

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Nivolumab is an immune checkpoint inhibitor used in the treatment of several types of cancer. Among the adverse effects of this drug, immune-mediated colitis (IMC) has been described. However, in contrast to other checkpoint inhibitors, such as ipilimumab, drug-induced colitis due to nivolumab is not commonly reported.

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Article Synopsis
  • Baseline assessment and regular monitoring using patient history, clinical exams, lab tests, and noninvasive imaging can help detect side effects from immune checkpoint inhibitors early.
  • The text highlights various cardiotoxic effects linked to immune checkpoint inhibitors, including conditions like pericarditis and myocarditis.
  • A case study is presented of a middle-aged man with advanced esophageal cancer who experienced acute heart failure due to nivolumab-induced cardiotoxicity, despite having no prior heart issues or significant risk factors.
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Nivolumab belongs to immune checkpoint inhibitors (ICIs). ICIs-induced kidney injury is rare and acute interstitial nephritis (AIN) is the majority. A 58-year-old woman had gastric cancer treated with nivolumab.

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