Jegan Niwas Kannan¹*, Varshini Selvaraj² and Ramanan SG³

¹Consultant Medical Oncologist, Madras Cancer Care Foundation, Chennai, India
²Clinical Research Specialist, Madras Cancer Care Foundation, Chennai, India
³Senior Consultant Medical Oncologist, Madras Cancer Care Foundation, Chennai, India

*Corresponding Author: Jegan Niwas Kannan, Consultant Medical Oncologist, Madras Cancer Care Foundation, Chennai, India.

Received: May 28, 2025; Published: June 23, 2025

Abstract

Background: Immune checkpoint inhibitors (ICIs), particularly pembrolizumab, have revolutionized the treatment of metastatic clear cell renal cell carcinoma (ccRCC). However, ICIs can lead to immune-related adverse events (irAEs), with neurological complications like Guillain-Barré Syndrome (GBS) being rare but potentially life-threatening.

Case Presentation: A 60-year-old male presented with loss of appetite and left loin pain. Imaging revealed a 6.8 × 5.8 cm mass in the mid-third of the left kidney, with PET-CT confirming FDG-avid lesions and lymphadenopathy. Histopathology confirmed poorly differentiated ccRCC. The patient commenced treatment with pembrolizumab and Axitinib.

After the first cycle, he developed progressive lower limb weakness, requiring assistance for ambulation. Neurological examination showed motor weakness (3/5) in lower limbs, absent tendon reflexes, preserved sensation, and intact bladder/bowel function. MRI spine was unremarkable. CSF analysis revealed elevated protein (117 mg/dL) without pleocytosis; nerve conduction studies indicated bilateral motor neuropathy in lower limbs. A diagnosis of ICI-induced GBS was made. The patient received intravenous methylprednisolone followed by oral corticosteroids, leading to gradual improvement.

Conclusion: This case underscores the importance of early recognition and management of rare neurological irAEs like GBS in patients undergoing ICI therapy. Clinicians should maintain a high index of suspicion for GBS in patients presenting with neurological symptoms during ICI treatment. Prompt diagnosis and intervention are crucial for favourable outcomes.

Keywords:Guillain-Barré Syndrome; Pembrolizumab; Clear Cell Renal Cell Carcinoma; Immune Checkpoint Inhibitors; Immune-Related Adverse Events

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Citation

Citation: Jegan Niwas Kannan., et al. “Guillain-Barré Syndrome Induced by Pembrolizumab in a Patient with Metastatic Clear Cell Renal Cell Carcinoma: A Case Report". Acta Scientific Clinical Case Reports 6.7 (2025): 18-22.

Copyright

Copyright: © 2025 Jegan Niwas Kannan., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.