Neuronal intermediate filament neurologic autoimmunity in a patient with Merkel cell carcinoma receiving pembrolizumab.
A 55-year-old woman with recurrent stage IIIA Merkel cell carcinoma developed vertigo, gait instability, dysarthria, and persistent right hemifacial and cervical spasms after her second pembrolizumab dose.
Clinical pearl
With new neurologic symptoms during immune checkpoint inhibitor therapy, consider paraneoplastic NIF autoimmunity; an unremarkable brain MRI does not exclude it, and CSF antibody testing may support the diagnosis.