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Refractory to the conventional management of IRAEs with corticosteroids, the patient was successfully treated with intravenous immunoglobulins (IVIG), followed by tocilizumab and mycophenolate mofetil (MMF), ultimately resulting in complete radiological resolution of ADEM. This case highlights the importance of early suspicion, identification and management of IRAEs when oncology patients present acutely.<\/jats:p>","DOI":"10.1136\/bcr-2024-263711","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T04:16:11Z","timestamp":1749096971000},"page":"e263711","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Steroid refractory immune-related acute disseminated encephalomyelitis (ADEM) successfully treated with 2nd and 3rd line immunosuppressive therapy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6739-0690","authenticated-orcid":false,"given":"Cathryn Ann","family":"Rees","sequence":"first","affiliation":[{"name":"Oncology, Velindre Cancer Centre, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisling","family":"Butler","sequence":"additional","affiliation":[{"name":"Oncology, Velindre Cancer Centre, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shree","family":"Muthukrishnan","sequence":"additional","affiliation":[{"name":"Velindre Cancer Centre, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricky Dylan","family":"Frazer","sequence":"additional","affiliation":[{"name":"Oncology, Velindre University NHS Trust, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"2025082710572537000_18.6.e263711.1","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2021.39.15_suppl.2647","article-title":"Consensus disease definitions for the spectrum of neurologic immune related adverse events","volume":"39","author":"Guidon","year":"2021","journal-title":"JCO"},{"key":"2025082710572537000_18.6.e263711.2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0359"},{"key":"2025082710572537000_18.6.e263711.3","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines12061319","article-title":"Neurological Immune-Related Adverse Events Induced by Immune Checkpoint Inhibitors","volume":"12","author":"Stavropoulou De Lorenzo","year":"2024","journal-title":"Biomedicines"},{"key":"2025082710572537000_18.6.e263711.4","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1590\/0004-282x-anp-2022-s116","article-title":"Neurologic adverse events of cancer immunotherapy","volume":"80","author":"Brito","year":"2022","journal-title":"Arq Neuropsiquiatr"},{"key":"2025082710572537000_18.6.e263711.5","unstructured":"Anilkumar AC , Foris LA , Tadi P . 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