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Immunol."],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) are drugs that are being increasingly used in the field of oncology; due to their mechanism of action, they can present immune-related adverse effects (IRAEs), with various clinical manifestations, one of which is delirium. We present the case of a patient diagnosed with pleural mesothelioma that started combined palliative immunotherapy two months before admission. She was hospitalized for delirium with psychotic symptoms and a comprehensive neurological and etiological examination for this pathology was performed, revealing undetectable TSH levels, indicating the etiology of the condition as thyrotoxicosis in the context of autoimmune thyroiditis, secondary to treatment with ICIs. Symptomatic treatment with beta-blockers was initiated, leading to progressive improvement. This case brings awareness of impaired consciousness and neuropsychiatric symptoms as manifestation of IRAEs and the difficulty of their diagnosis: there may also be several other causes of impaired consciousness, so the characterization of delirium requires a multifaceted approach to determine the underlying cause, taking into account direct cancer-related complications and those stemming from the treatments received by this group of patients. Endocrinological immune-related adverse events (IRAEs), such as thyroid IRAEs, generally have a low lethality rate, do not necessarily require discontinuation of therapy, and are linked to a more favorable oncological prognosis. Conversely, neurological IRAEs, though rare, constitute a contraindication for further use of ICIs. This clinical case emphasizes the importance of the systematic study of consciousness impairment in cancer patients, and of considering multiple IRAEs that could lead to changes in oncological therapy when establishing possible etiologies.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1458686","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T06:43:33Z","timestamp":1738305813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: Diagnosis of impaired consciousness in a cancer patient using immune checkpoint inhibitors"],"prefix":"10.3389","volume":"16","author":[{"given":"Daniel","family":"Cathalifaud","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crist\u00f3bal","family":"Bas\u00e1ez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana","family":"Y\u00e1\u00f1ez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-019-0218-0","article-title":"Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance","volume":"16","author":"Martins","year":"2019","journal-title":"Nat Rev Clin Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.7326\/AITC202010060","article-title":"Delirium","volume":"173","author":"Mattison","year":"2020","journal-title":"Ann Intern Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.101967","article-title":"Psychiatric disorders associated with immune checkpoint inhibitors: a pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database","volume":"59","author":"Zhou","year":"2023","journal-title":"EClinicalMedicine [Internet]"},{"key":"B5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/pnp.555","article-title":"Mania as a possible complication of immunotherapy","volume":"24","author":"Mavrotas","year":"2020","journal-title":"Prog Neurol Psychiatry [Internet]"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.3782-19","article-title":"Neuropsychiatric immune-related adverse events induced by pembrolizumab in a patient with lung adenocarcinoma and systemic lupus erythematosus","volume":"59","author":"Jono","year":"2020","journal-title":"Intern Med [Internet]"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.3818","article-title":"Recognizing encephalopathy in immune checkpoint inhibitor therapy: a single-center experience","volume":"10","author":"Wei","year":"2021","journal-title":"Cancer Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7893.2008.00105.x","article-title":"Initial medical work-up of first-episode psychosis: a conceptual review","volume":"3","author":"Freudenreich","year":"2009","journal-title":"Early Interv Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70220-9","article-title":"Neurological complications of systemic cancer","volume":"9","author":"Khasraw","year":"2010","journal-title":"Lancet Neurol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25708","article-title":"Severe neurological toxicity of immune checkpoint inhibitors: growing spectrum","volume":"87","author":"Dubey","year":"2020","journal-title":"Ann Neurol [Internet]"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2023.03.005","article-title":"Immune checkpoint inhibitor-related thyroid dysfunction","volume":"84","author":"Illouz","year":"2023","journal-title":"Ann Endocrinol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s10238-023-01082-5","article-title":"Immune-related thyroid dysfunctions during anti PD-1\/PD-L1 inhibitors: new evidence from a single centre experience","volume":"23","author":"Nervo","year":"2023","journal-title":"Clin Exp Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.19052","article-title":"Hyperthyroidism: A review","volume":"330","author":"Lee","year":"2023","journal-title":"JAMA"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02016-0","article-title":"Hyperthyroidism","volume":"403","author":"Chaker","year":"2024","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1420438","article-title":"Psychoses associated with thyrotoxicosis - 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