Abstract Background Nivolumab is an immune checkpoint inhibitor with indications for multiple malignancies. New reports of adverse events continue to emerge, including one Case report of nivolumab-associated akathisia. We describe a second case of likely nivolumab-induced akathisia. Case A 68-year-old female with metastatic renal cell carcinoma presented with restlessness that became acutely debilitating approximately fourth months after initiating treatment with nivolumab. Psychiatric evaluation revealed no psychiatric history and no current mood, anxiety, or psychotic symptoms. She had intermittently taken prochlorperazine as needed for nausea. An extensive medical workup was unrevealing for any cause of her symptoms. The clinical picture progressed to involve parkinsonian features in addition to the restlessness. Unfortunately all of the patient’s symptoms were refractory to typical treatments including benzodiazepines, propranolol, iron supplementation, carbidopa-levodopa, and ropinirole. After a four-week hospitalization with minimal improvement, she discharged home on hospice and passed away a month later. Discussion There is one prior Case report of nivolumab-induced debilitating akathisia. As with our case, that patient had severe akathisia unresponsive to numerous treatments. In both cases, no medication trial resulted in significant improvement and both patients died soon after developing akathisia. Conclusion The side effect profile of immune checkpoint inhibitors remains incompletely characterized. This is the second reported Case of treatment-resistant akathisia likely associated with nivolumab use and provides further context for future investigations into checkpoint inhibitor-induced neurotoxicities.

中文翻译：

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纳武单抗治疗转移性肾细胞癌患者静坐不能病例报告

摘要 背景 Nivolumab 是一种免疫检查点抑制剂，适用于多种恶性肿瘤。不良事件的新报告不断出现，包括一份纳武单抗相关静坐不能的病例报告。我们描述了可能是纳武单抗引起的静坐不能的第二例。病例 一名患有转移性肾细胞癌的 68 岁女性出现躁动，在开始使用纳武单抗治疗后大约第四个月变得极度虚弱。精神病学评估显示没有精神病史，也没有当前的情绪、焦虑或精神病症状。她因恶心需要间歇性服用丙氯拉嗪。广泛的医学检查并未发现导致她症状的任何原因。除了烦躁不安之外，临床表现还包括帕金森病特征。不幸的是，该患者的所有症状都难以接受典型的治疗，包括苯二氮卓类药物、普萘洛尔、补铁剂、卡比多巴-左旋多巴和罗匹尼罗。经过 4 周的住院治疗，但几乎没有改善，她出院回家接受临终关怀，并在一个月后去世。讨论 之前有一份纳武单抗引起的衰弱性静坐不能病例报告。与我们的病例一样，该患者患有严重的静坐不能，对多种治疗无反应。在这两种情况下，没有药物试验导致显着改善，两名患者在出现静坐不能后不久就死亡。结论 免疫检查点抑制剂的副作用特征仍未完全表征。