Objective:

Background:

For metastatic melanoma, the field of oncology favors usage of nivolumab (PD-1 checkpoint inhibitor) and ipilimumab (CTLA-4 checkpoint inhibitor) as first-line therapy. Due to their disinhibition of T-cell response, the immune checkpoint inhibitors (ICIs) can have adverse immune-based reactions involving various organ systems. Neurologically, they have been associated with new lesions and disease progression in pwMS. They have also been associated with other demyelinating disease processes including neuromyelitis optica spectrum disorder (NMOSD) and Guillain-Barre syndrome (GBS).

Design/Methods:

Case report with MRI images, PET scan & pathology reports.

Results:

46-year-old male with RRMS since 2006 most recently on ocrelizumab since 2019. He had melanoma twice with wide local excision (5/2015, 9/2015) with negative sentinel lymph node biopsy. In 2023, he reported rapid onset visual symptoms and was found to have a right homonymous hemianopia. Imaging revealed 2 lesions new since imaging 12 months prior—a large hemorrhagic lesion in the left occipital lobe with an enhancing nodule, and a dural-based enhancing lesion which was excised and consistent with metastatic melanoma. He was treated with first-line therapy at a cancer center with neurologist clearance and with favorable PET scan response.

Conclusions:

In an article summarizing 16 patients with MS who had received an ICI, 37.5% had melanoma and 50% of patients had at least one immune-related adverse event (irAE). We aim to highlight a patient with a ~16 year history of RRMS diagnosed with widespread melanoma with CNS involvement; he was treated with ICI therapy with favorable response. In aggressive and potentially life-threatening disease, treatment with ICIs may be considered if the potential benefit outweighs the risk of possible irAEs.