Elevated Adenosine Deaminase Levels in the Cerebrospinal Fluid in Immune Checkpoint Inhibitor-induced Autoimmune Encephalitis

Intern Med. 2019 Oct 1;58(19):2871-2874. doi: 10.2169/internalmedicine.2537-18. Epub 2019 Jun 27.

Abstract

Immune checkpoint inhibitors (ICIs) are promising drugs for various cancers. However, immune activation by ICIs can lead to immune-related adverse events (irAEs). Autoimmune encephalitis is a rare irAE, and its clinical features remain unknown. We herein report two patients with ICI-associated autoimmune encephalitis who, saliently, showed elevated adenosine deaminase (ADA) levels in the cerebrospinal fluid (CSF). This is the first report of increased ADA levels in the CSF of patients with ICI-induced autoimmune encephalitis. Although the mechanism of the ADA increase is poorly understood, elevated ADA in the CSF may be informative in the diagnosis of this rare disorder.

Keywords: adenosine deaminase; autoimmune encephalitis; cerebrospinal fluid; immune checkpoint inhibitor; immune-related adverse event.

Publication types

  • Case Reports

MeSH terms

  • Adenosine Deaminase / cerebrospinal fluid*
  • Aged
  • Biomarkers / cerebrospinal fluid
  • Encephalitis / cerebrospinal fluid
  • Encephalitis / chemically induced*
  • Encephalitis / immunology
  • Hashimoto Disease / cerebrospinal fluid
  • Hashimoto Disease / chemically induced*
  • Hashimoto Disease / immunology
  • Humans
  • Immunologic Factors / adverse effects*
  • Lung Neoplasms / drug therapy
  • Male

Substances

  • Biomarkers
  • Immunologic Factors
  • Adenosine Deaminase

Supplementary concepts

  • Hashimoto's encephalitis