Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T07:31:21.053Z Has data issue: false hasContentIssue false
  • English
  • Français

Wernicke encephalopathy in a lung cancer patient during treatment with nivolumab

Published online by Cambridge University Press:  03 August 2018

Hideki Onishi ,
Mayumi Ishida ,
Hiroshi Kagamu ,
Yoshitake Murayama ,
Kunihiko Kobayashi ,
Izumi Sato ,
Nozomu Uchida  and
Tatsuo Akechi
Hideki Onishi*
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Mayumi Ishida
Affiliation:
Department of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Hiroshi Kagamu
Affiliation:
Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Yoshitake Murayama
Affiliation:
Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Kunihiko Kobayashi
Affiliation:
Department of Respiratory Medicine, Saitama Medical University International Medical Center, Saitama, Japan
Izumi Sato
Affiliation:
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Saitama, Japan
Tatsuo Akechi
Affiliation:
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. It is recognized in various stages of the cancer trajectory but has not previously been recognized during nivolumab treatment.

Method

From a series of WE patients with cancer, we report a lung cancer patient who developed WE during treatment with nivolumab.

Result

A 78-year-old woman with lung cancer was referred to our psycho-oncology clinic because of depressed mood. Psychiatric examination revealed disorientation to time, date, and place, which had not been recognized 1 month previously. Her symptoms fulfilled the diagnostic criteria for delirium. No laboratory findings or drugs explaining her delirium were identified. WE was suspected as she experienced a loss of appetite lasting 4 weeks. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after intravenous thiamine administration.

Significance of results

We found WE in an advanced lung cancer patient receiving treatment with nivolumab. Further study revealed the association between nivolumab and thiamine deficiency. Oncologists should consider thiamine deficiency when a patient experiences a loss of appetite of more than 2 weeks regardless of the presence or absence of delirium.

Keywords

ThiamineNivolumabWernicke encephalopathyDeliriumCancer
Type
Case Report
Information
Palliative & Supportive Care , Volume 17 , Issue 2 , April 2019 , pp. 245 - 247
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aksoy, M, Basu, TK, Brient, J, et al. (1980) Thiamin status of patients treated with drug combinations containing 5-fluorouracil. European Journal of Cancer 16, 1041–1045.Google Scholar
American Psychiatric Association (2000) Diagnostic and Statistical manual of mental disorders 4th edition text revision. Washington DC: American Psychiatric Press.Google Scholar
Basu, TK, Aksoy, M, & Dickerson, JW (1979) Effects of 5-fluorouracil on the thiamin status of adult female rats. Chemotherapy 25, 70–76.Google Scholar
Isenberg-Grzeda, E, Alici, Y, Hatzoglou, V, et al. (2016a) Nonalcoholic thiamine-related encephalopathy (Wernicke-Korsakoff syndrome) among inpatients with cancer: A series of 18 cases. Psychosomatics 57, 71–81.Google Scholar
Isenberg-Grzeda, E, Hsu, AJ, Hatzoglou, V, et al. (2014) Palliative treatment of thiamine-related encephalopathy (Wernicke's encephalopathy) in cancer: A case series and review of the literature. Palliative and Supportive Care 13, 1241–1249.Google Scholar
Isenberg-Grzeda, E, Kutner, HE, & Nicolson, SE (2012) Wernicke-Korsakoff-syndrome: Under-recognized and under-treated. Psychosomatics 53, 507–516.Google Scholar
Isenberg-Grzeda, E, Rahane, S, DeRosa, AP, et al. (2016b) Wernicke-Korsakoff syndrome in patients with cancer: A systematic review. Lancet Oncology 17, e142–e148.Google Scholar
Isenberg-Grzeda, E, Shen, MJ, Alici, Y, et al. (2017) High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: Results of a single site prevalence study. Psychooncology 26, 1384–1389.Google Scholar
MacLean, LD, Rhode, BM, & Shizgal, HM (1983) Nutrition following gastric operations for morbid obesity. Annals of Surgery 198, 347–355.Google Scholar
Ohe, Y, Ohashi, Y, Kubota, K, et al. (2007) Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non-small-cell lung cancer: Four-Arm Cooperative Study in Japan. Annals of Oncology 18, 317–323.Google Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2017a) Subclinical thiamine deficiency in patients with abdominal cancer. Palliative and Supportive Care 1–3.Google Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2017b) Wernicke encephalopathy without delirium in patients with cancer. Palliative and Supportive Care 1–3.Google Scholar
Onishi, H, Ishida, M, Tanahashi, I, et al. (2018) Wernicke encephalopathy without delirium in patients with cancer. Palliative and Supportive Care 16, 118–121.Google Scholar
Onishi, H, Ishida, M, Toyama, H, et al. (2016) Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. Palliative and Supportive Care 14, 302–306.Google Scholar
Onishi, H, Kawanishi, C, Onose, M, et al. (2004) Successful treatment of Wernicke encephalopathy in terminally ill cancer patients: Report of 3 cases and review of the literature. Supportive Care in Cancer 12, 604–608.Google Scholar
Pardanani, A, Harrison, C, Cortes, JE, et al. (2015) Safety and efficacy of fedratinib in patients with primary or secondary myelofibrosis: A randomized clinical trial. JAMA Oncology 1, 643–651.Google Scholar
Postow, MA (2015) Managing immune checkpoint-blocking antibody side effects. American Society of Clinical Oncology Educational Book 76–83.Google Scholar
Sechi, G, Batzu, L, Agro, L, et al. (2016a) Cancer-related Wernicke-Korsakoff syndrome. Lancet Oncology 17, e221–e222.Google Scholar
Sechi, G, Sechi, E, Fois, C, et al. (2016b). Advances in clinical determinants and neurological manifestations of B vitamin deficiency in adults. Nutrition Review 74, 281–300.Google Scholar
Sechi, G and Serra, A (2007) Wernicke's encephalopathy: New clinical settings and recent advances in diagnosis and management. Lancet Neurology 6, 442–455.Google Scholar
Spain, L, Walls, G, Julve, M, et al. (2017) Neurotoxicity from immune-checkpoint inhibition in the treatment of melanoma: A single centre experience and review of the literature. Annals of Oncology 28, 377–385.Google Scholar
Victor, M, Adams, RD, & Collins, GH (1971) The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemporary Neurology Series 7, 1–206.Google Scholar
Zhang, Q, Zhang, Y, Diamond, S, et al. (2014) The Janus kinase 2 inhibitor fedratinib inhibits thiamine uptake: A putative mechanism for the onset of Wernicke's encephalopathy. Drug Metabolism and Disposition 42, 1656–1662.Google Scholar