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Abstract

Background and Objectives

We present the case of a 67-year-old man who developed encephalopathy, headaches, and seizure activity after initiating treatment with the novel tyrosine kinase inhibitor, sitravatinib.

Methods

The patient was identified in routine clinical practice.

Results

Brain MRI revealed lobar microhemorrhages and bihemispheric vasogenic edema. The patient met the criteria for probable cerebral amyloid angiopathy–related inflammation (CAA-ri) and responded favorably to high-dose methylprednisolone.

Discussion

This report of neurologic autoimmunity in a patient receiving sitravatinib opens new lines of inquiry into the pathophysiology of CAA-ri. We emphasize the importance of early recognition and treatment of CAA-ri among patients receiving immunomodulatory chemotherapy.

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References

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Auriel E, Charidimou A, Gurol ME, et al. Validation of clinicoradiological criteria for the diagnosis of cerebral amyloid angiopathy–related inflammation. JAMA Neurol. 2016;73(2):197.
2.
Du W, Huang H, Sorrelle N, Brekken RA. Sitravatinib potentiates immune checkpoint blockade in refractory cancer models. JCI Insight. 2018;3(21):e124184.
3.
Wium M, Paccez JD, Zerbini LF. The dual role of TAM receptors in autoimmune diseases and cancer: an overview. Cells. 2018;7(10):166.
4.
Szilveszter KP, Németh T, Mócsai A. Tyrosine kinases in autoimmune and inflammatory skin diseases. Front Immunol. 2019;10:1862.
5.
Kerkemeyer KLS, Lai FYX, Mar A. Lichen planus pemphigoides during therapy with tislelizumab and sitravatinib in a patient with metastatic lung cancer. Australas J Dermatol. 2020;61(2):180-182.
6.
Wu J-J, Yao M, Ni J. Cerebral amyloid angiopathy-related inflammation: current status and future implications. Chin Med J (Engl). 2021;134(6):646-654.
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Lasocki A, Kee D. Clinical and radiological evolution of cerebral amyloid angiopathy-related inflammation in the context of anti-PD-1 immunotherapy. Melanoma Res. 2020;30(6):608-612.

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 12Number 2April 2022
Pages: e4-e6

Publication History

Received: October 12, 2021
Accepted: February 2, 2022
Published online: March 1, 2022
Published in print: April 2022

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Disclosure

The authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Department of Neurology, Washington University School of Medicine.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Spouse's support: (1) NIH NIDDK, 1L40DK126092-01, Loan Repayment Award Recipient, 2 (2) NIH NIDA, T32 DA007261, T32 Trainee, 2 (3) NIH NCATS, KL2TR002346, KL2 Career Development Scholar, 2
Research Support, Academic Entities:
1.
Spouse's support: (1) Washington University in St. Louis Diabetes Research Center (2) Washington University in St. Louis and BJC Healthcare Innovation Lab
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Department of Neurology, Washington University School of Medicine.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH NCI, U54 CA199092-05S1, co-investigator, 2019-2021
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Ray [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

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Cited By
  1. Sitravatinib, Reactions Weekly, 1914, 1, (399-399), (2022).https://doi.org/10.1007/s40278-022-18985-2
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