CASPR2 antibody-associated neurological syndrome after PD-1 inhibitor treatment (tislelizumab) in a patient with lung adenocarcinoma: A case report and literature review.
Lingfang Zhang, Xiaohui Tai, Xuhui Zhao et al.
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Case in brief
A 46-year-old woman with advanced non-small cell lung cancer developed cerebellar, cognitive, and autonomic symptoms one week after her second tislelizumab cycle. Serum testing detected CASPR2 antibodies at 1:30 by cell-based assay; CSF testing was negative, and brain MRI lacked typical inflammatory changes. Her neurological symptoms resolved completely within one week of high-dose methylprednisolone and intravenous immunoglobulin. Tislelizumab was permanently discontinued. She later died at home; the cause was unclear, although disease progression was suspected.
What made this case unusual
The presentation combined cerebellar syndrome with cognitive and autonomic symptoms despite negative CSF CASPR2 antibodies and no typical inflammatory MRI findings, complicating recognition in a patient with lung cancer.
Diagnostic / clinical pearl
CASPR2-associated neurological disease after PD-1 inhibitor exposure may present with cerebellar, cognitive, and autonomic features; negative CSF antibody testing and non-inflammatory MRI do not exclude it when serum antibodies are detected.
Why it matters
Neurological symptoms in patients receiving checkpoint inhibitors can overlap with manifestations of brain metastases, making consideration of an immune-mediated syndrome important.