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The patient's condition rapidly deteriorated after the second dose of nivolumab, demonstrating hemiplegia, seizures, and eventually unresponsiveness with a fixed and dilated left pupil. Computed tomography of her brain revealed malignant cerebral edema requiring emergency decompressive hemicraniectomy. Repeat imaging demonstrated increased size of the lesion, reflecting immune-mediated inflammation and tumor necrosis. The patient remained densely hemiplegic, but became progressively more interactive and was ultimately extubated. She resumed nivolumab several weeks later, but again her condition deteriorated with headache, vomiting, swelling at the craniectomy site, and limited right-sided facial movement following the sixth dose. MRI demonstrated severe midline shift and uncal herniation despite her craniectomy. Her condition gradually declined, and she died several days later under \u201cdo not resuscitate\/do not intubate\u201d orders. To the authors' knowledge, this represents the first case of malignant cerebral edema requiring operative intervention following nivolumab treatment for glioblastoma in a pediatric patient.<\/jats:p>","DOI":"10.3171\/2016.8.peds16326","type":"journal-article","created":{"date-parts":[[2016,11,18]],"date-time":"2016-11-18T14:58:35Z","timestamp":1479481115000},"page":"249-253","source":"Crossref","is-referenced-by-count":42,"title":["Severe cerebral edema following nivolumab treatment for pediatric glioblastoma: case report"],"prefix":"10.3171","volume":"19","author":[{"given":"Xiao","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M.","family":"McDowell","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary E.","family":"Mason","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Greene","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep S.","family":"Tamber","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-peds16326","series-title":"Ann Oncol","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1093\/annonc\/mdv622","article-title":"Clinical outcomes of melanoma brain metastases treated with stereotactic radiation and anti-PD-1 therapy","volume":"27","author":"Ahmed KA,","year":"2016","unstructured":"Ahmed KA, Stallworth DG, Kim Y, Johnstone PA, Harrison LB, Caudell JJ, : Clinical outcomes of melanoma brain metastases treated with stereotactic radiation and anti-PD-1 therapy. 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