{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:26:04Z","timestamp":1787505964875,"version":"build-2736575974"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T00:00:00Z","timestamp":1647648000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T00:00:00Z","timestamp":1647648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Longitudinal extensive transverse myelitis is a rare and potentially life-threatening complication of chemoradiation. Certain chemotherapy agents have been proposed to increased neurotoxicity with chemoradiation therapy. One such agent is durvalumab, a human IgG1 monoclonal antibody that blocks programmed death ligand 1, allowing T-cells to recognize and kill tumor cells. Durvalumab and other immune checkpoint inhibitors may also cause transverse myelitis without concomitant treatment with radiation. Durvalumab is a standard therapy for non-small cell lung carcinoma. Here we present a case of a 68-year-old male who presented after chemoradiation and durvalumab therapy with transverse myelitis extending outside the irradiation site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 68-year-old male presented to the emergency department with pain and weakness in his feet and hesitancy of urination. Medical history is significant for non-small cell lung cancer treated with chemoradiotherapy and consolidation therapy with durvalumab for one year. His last radiation treatment was 15\u2009months prior, and his last infusion of durvalumab was 3\u2009months prior. Exam revealed severe weakness of bilateral legs with absent vibration sensation. MRI showed central longitudinal extensive transverse myelitis extending from C4-T11. CSF studies showed 8 WBC with 63% lymphocyte predominance and a protein of 48. Oligoclonal bands and angiotensin-converting enzyme were negative. Serum Neuromyelitis Optica antibody (AQP4-IgG) and Myelin oligodendrocyte glycoprotein antibody (MOG-IgG) were negative. Infectious workup came back negative. The patient was treated with steroids and plasma exchange with mild improvement. Etiology remained unknown, but longitudinal extensive transverse myelitis following durvalumab chemoradiotherapy was thought to be the likely cause. He was discharged on a high-dose prednisone taper with outpatient follow-up. His condition worsened near the end of the steroid taper. High-dose prednisone and cyclophosphamide infusions were started with mild improvement and stabilization of the patient\u2019s condition. He transitioned to methotrexate after completion of six cyclophosphamide infusions. The patient expired due to complications from his cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Longitudinal extensive transverse myelitis is a rare and potentially life-threatening complication of durvalumab therapy. As durvalumab has become a standard treatment for non-small cell lung cancer, it is important to be able to identify and treat side effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-022-02576-7","type":"journal-article","created":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T06:03:42Z","timestamp":1647669822000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Longitudinal extensive transverse myelitis after chemoradiation therapy with durvalumab, a rare complication: case report"],"prefix":"10.1186","volume":"22","author":[{"given":"Travis","family":"Moodie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Alshaqi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4129-2455","authenticated-orcid":false,"given":"Abdul","family":"Alchaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,19]]},"reference":[{"issue":"5","key":"2576_CR1","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/j.neurol.2020.08.003","volume":"177","author":"R Marignier","year":"2021","unstructured":"Marignier R. Acute and subacute myelopathy. Rev Neurol (Paris). 2021;177(5):557\u201366. https:\/\/doi.org\/10.1016\/j.neurol.2020.08.003 Epub 2020 Oct 21. PMID: 34024334.","journal-title":"Rev Neurol (Paris)"},{"issue":"3","key":"2576_CR2","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1016\/j.clineuro.2005.11.008","volume":"108","author":"VV Brinar","year":"2006","unstructured":"Brinar VV, Habek M, Brinar M, Malojci\u0107 B, Boban M. The differential diagnosis of acute transverse myelitis. Clin Neurol Neurosurg. 2006;108(3):278\u201383. https:\/\/doi.org\/10.1016\/j.clineuro.2005.11.008 Epub 2005 Dec 20. PMID: 16376014.","journal-title":"Clin Neurol Neurosurg"},{"issue":"3","key":"2576_CR3","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1007\/s13691-019-00367-5","volume":"8","author":"K Kubo","year":"2019","unstructured":"Kubo K, Wadasaki K, Yamane H, Doi M. Radiation myelitis after durvalumab administration following chemoradiotherapy for locally advanced non-small cell lung cancer: an illustrative case report and review of the literature. Int Cancer Conf J. 2019;8(3):118\u201321. Published 2019 Mar 13. https:\/\/doi.org\/10.1007\/s13691-019-00367-5.","journal-title":"Int Cancer Conf J"},{"issue":"8","key":"2576_CR4","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/0360-3016(79)90663-1","volume":"5","author":"JC Ruckdeschel","year":"1979","unstructured":"Ruckdeschel JC, Baxter DH, McKneally MF, Killam DA, Lunia SL, Horton J. Sequential radiotherapy and adriamycin in the management of bronchogenic carcinoma: the question of additive toxicity. Int J Radiat Oncol Biol Phys. 1979;5(8):1323\u20138. https:\/\/doi.org\/10.1016\/0360-3016(79)90663-1 PMID: 528285.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"20","key":"2576_CR5","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1056\/NEJMoa1709937","volume":"377","author":"SJ Antonia","year":"2017","unstructured":"Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017;377(20):1919\u201329. https:\/\/doi.org\/10.1056\/NEJMoa1709937 Epub 2017 Sep 8. PMID: 28885881.","journal-title":"N Engl J Med"},{"key":"2576_CR6","doi-asserted-by":"publisher","unstructured":"Wang L, Lou H, Li B, Li J, Yang YM. Paraneoplastic myelitis associated with durvalumab treatment for extensive-stage small cell lung cancer. Investig New Drugs. 2021. https:\/\/doi.org\/10.1007\/s10637-021-01154-x Epub ahead of print. PMID: 34287773.","DOI":"10.1007\/s10637-021-01154-x"},{"issue":"8","key":"2576_CR7","doi-asserted-by":"publisher","first-page":"2121","DOI":"10.1002\/art.10461","volume":"46","author":"FA Houssiau","year":"2002","unstructured":"Houssiau FA, Vasconcelos C, D'Cruz D, Sebastiani GD, Garrido Ed ER, Danieli MG, et al. Immunosuppressive therapy in lupus nephritis: the euro-lupus nephritis trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide. Arthritis Rheum. 2002;46(8):2121\u201331. https:\/\/doi.org\/10.1002\/art.10461 PMID: 12209517.","journal-title":"Arthritis Rheum"},{"key":"2576_CR8","doi-asserted-by":"publisher","unstructured":"Oliveira MCB, de Brito MH, Simabukuro MM. Central nervous system demyelination associated with immune checkpoint inhibitors: review of the literature. Front Neurol. 2020;11. https:\/\/doi.org\/10.3389\/fneur.2020.538695.","DOI":"10.3389\/fneur.2020.538695"},{"key":"2576_CR9","doi-asserted-by":"publisher","unstructured":"Picca A, Berzero G, Bihan K, Jachiet V, Januel E, Coustans M, Cauquil C, Perrin J, Berlanga P, Kramkimel N, Garel B, Devic P, Ducray F, Benazra M, Bompaire F, Leclercq D, Michot JM, Ammari S, Psimaras D. Longitudinally Extensive Myelitis Associated With Immune Checkpoint Inhibitors. Neurol Neuroimmunol Neuroinflamm. 2021;8(3):e967. https:\/\/doi.org\/10.1212\/NXI.0000000000000967.","DOI":"10.1212\/NXI.0000000000000967"},{"issue":"5","key":"2576_CR10","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1016\/j.ijrobp.2007.11.075","volume":"71","author":"TE Schultheiss","year":"2008","unstructured":"Schultheiss TE. The radiation dose-response of the human spinal cord. Int J Radiat Oncol Biol Phys. 2008;71(5):1455\u20139. https:\/\/doi.org\/10.1016\/j.ijrobp.2007.11.075 Epub 2008 Feb 19. PMID: 18243570.","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-022-02576-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-022-02576-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-022-02576-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T06:03:52Z","timestamp":1647669832000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-022-02576-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,19]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["2576"],"URL":"https:\/\/doi.org\/10.1186\/s12883-022-02576-7","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,19]]},"assertion":[{"value":"5 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 March 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The case report is approved by USD\/Sanford health ethics committee. A case report is waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s family for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors have nothing to declare. No financial or non-financial competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"107"}}