阿特朱单抗和贝伐单抗治疗是不可切除的肝细胞癌的一线疗法。尽管免疫检查点抑制剂是新颖且有效的治疗方法，但它们可以诱发免疫相关的不良事件。然而，与神经免疫相关的不良事件却很少报道。我们报道了一名 40 多岁的肝细胞癌男性患者，在服用阿特珠单抗加贝伐珠单抗后出现危及生命的脑炎。给药十天后，患者出现发烧、头痛、精神改变和全身癫痫发作。脑脊液分析显示白细胞和蛋白质水平升高，但未发现感染或恶性肿瘤。脑磁共振成像显示大脑和小脑的弥漫性软脑膜增强。由于强烈怀疑是免疫检查点抑制剂诱发的脑炎，因此开始类固醇冲击治疗，神经系统症状迅速改善。患者住院66天后出院，并在门诊开始接受索拉非尼和肝细胞癌放疗。该病例证明了在阿替利珠单抗和贝伐单抗治疗后识别神经免疫相关不良事件以进行早期干预的重要性。我们将此病例与现有文献以及之前阿特珠单抗和贝伐珠单抗诱导的肝细胞癌脑炎的两例进行比较来讨论。© 2024。作者。

Treatment with atezolizumab and bevacizumab is the first-line therapy for unresectable hepatocellular carcinoma. Although immune checkpoint inhibitors are novel and effective treatments, they can induce immune-related adverse events. However, neurological immune-related adverse events have rarely been reported. We report the case of a man in his 40s with hepatocellular carcinoma who developed life-threatening encephalitis after atezolizumab plus bevacizumab was administered. The patient presented with fever, headache, altered mentality, and general epileptic seizures, ten days after administration. Cerebrospinal fluid analysis showed elevated white blood cells and elevated protein levels, but revealed no infection or malignancy. Brain magnetic resonance imaging showed diffuse leptomeningeal enhancement in both the cerebrum and cerebellum. As immune checkpoint inhibitor-induced encephalitis was strongly suspected, steroid pulse therapy was initiated and neurological symptoms quickly improved. The patient was discharged after 66 days of hospitalization, and administration of sorafenib and radiotherapy was started for the hepatocellular carcinoma on an outpatient basis. This case demonstrates the importance of recognizing neurological immune-related adverse events following atezolizumab and bevacizumab treatment for early intervention. We discuss this case in comparison to available literature and previous two cases of Atezolizumab- and bevacizumab- induced encephalitis in hepatocellular carcinoma.© 2024. The Author(s).