CTLA-4 blockade with ipilimumab induces significant clinical benefit in a female with melanoma metastases to the CNS.

BACKGROUND: A 63-year-old female presented to her primary physician with numbness and weakness in her left leg, which progressed over several days to involve her entire lower extremities. MRI of the spine and brain revealed multiple metastases. The patient received ipilimumab and after 3 months experienced intermittent confusion and focal seizures. INVESTIGATIONS: Electroencephalogram and MRI scans of the spine and brain, followed by surgical removal of a left frontal cortical brain metastasis and subsequent histological and pathological analyses. DIAGNOSIS: Metastatic melanoma from an unknown primary tumor. MANAGEMENT: The patient was treated with ipilimumab on a compassionate-use program and dexamethasone, celecoxib, and levetiracetam to treat the symptoms and seizures. Postoperative stereotactic radiosurgery was initiated.