{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:37:32Z","timestamp":1781649452855,"version":"3.54.5"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) have been widely utilized in patients with cancer and established as a standard therapeutic modality for various solid tumors. Although generally well tolerated, ICIs can induce unique immune-related adverse events (irAEs) affecting systemic systems and organs, posing a significant challenge in clinical oncology practice. Neurological immune-related adverse events (N-irAEs) are relatively rare, but the clinical management of high-grade N-irAEs is extremely challenging and potentially life-threatening. Concurrently, the nonspecific manifestations and extensive differential diagnoses of N-irAEs render their diagnosis highly difficult, which may result in suboptimal clinical management. Herein, we report on a case of a patient with advanced breast cancer who developed severe adverse reactions subsequent to treatment with pucotenlimab and was diagnosed with anti-aquaporin 4 antibody (AQP4-Ab)-positive neuromyelitis optica spectrum disorder (NMOSD) following multidisciplinary discussion. Despite prompt administration of high-dose methylprednisolone and plasma exchange therapy, the patient\u2019s neurological symptoms progressively worsened, leading to multiple organ dysfunction syndrome and subsequent death. A literature review on N-irAEs is also presented.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1783590","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:39:20Z","timestamp":1777527560000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Severe neuromyelitis optica spectrum disorder induced by pucotenlimab: a case report and literature review"],"prefix":"10.3389","volume":"17","author":[{"given":"Ziyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Chengdu Fifth People\u2019s Hospital","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lankai","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chengdu Fifth People\u2019s Hospital","place":["Chengdu, Sichuan, 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