{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:15:15Z","timestamp":1792800915142,"version":"4.5.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"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 inhibitor (ICI)-associated transverse myelitis (TM) is a rare and severe neurological immune-related adverse event (n-irAE) with an incidence of &amp;lt; 0.01%, and the clinical management of steroid-unresponsive cases remains extremely challenging. This article reports the case of a 37-year-old male patient with biphasic pleural mesothelioma who developed ICI-associated TM after treatment with nivolumab combined with ipilimumab. Initial treatment with high-dose glucocorticoids plus intravenous immunoglobulin (IVIg) was ineffective. After mycophenolate mofetil (MMF) was added in combination with steroids for 1 month, the patient\u2019s neurological function showed slight improvement, and intramedullary contrast-enhanced signals on spinal MRI showed partial reduction. However, spinal cord cystic or myelomalacic changes suggested potentially irreversible parenchymal injury. Currently, the patient has restarted pemetrexed combined with carboplatin chemotherapy, and the disease status is stable. Based on recently published case series, case reports, and systematic reviews, this article discusses the second-line treatment strategies for steroid-unresponsive ICI-associated TM, aiming to provide a reference for clinical practice in managing such rare cases.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1933514","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:35:57Z","timestamp":1789968957000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Observational use of mycophenolate mofetil in probable steroid-unresponsive immune checkpoint inhibitor-associated transverse myelitis"],"prefix":"10.3389","volume":"17","author":[{"given":"Lingping","family":"Kong","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Imaging, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunsheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diansheng","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2025-335998","article-title":"Neurological immune-related adverse events with checkpoint inhibitor therapy: challenges for the neurologist","volume":"96","author":"Willis","year":"2025","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3779\/j.issn.1009-3419.2019.10.05","article-title":"Clinical diagnosis and treatment recommendations for adverse reaction in the nervous system related to immunocheckpoint inhibitor","volume":"22","author":"Shi","year":"2019","journal-title":"Zhongguo Fei Ai Za Zhi"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1130313","article-title":"Case series: Immune checkpoint inhibitor-induced transverse myelitis","volume":"14","author":"Chatterton","year":"2023","journal-title":"Front Neurol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(18)30828-3","article-title":"New therapeutic perspectives to manage refractory immune checkpoint-related toxicities","volume":"20","author":"Martins","year":"2019","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/pn-2024-004327","article-title":"Neurological complications of immune checkpoint inhibitors: a practical guide","volume":"25","author":"Carr","year":"2025","journal-title":"Pract Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"10194","DOI":"10.29011\/2574-710x.10194","article-title":"High dose cyclophosphamide for the treatment of severe immune checkpoint inhibitor related adverse events","volume":"8","author":"Davis","year":"2023","journal-title":"J Oncol Res Ther"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16279","article-title":"Beyond T cell toxicity - 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