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42-Year-Old Female with Fecal and Urinary Incontinence

Maggie, a 42-year-old female, presents complaining of leg weakness accompanied by fecal and urinary incontinence. Her medical history includes a diagnosis of nodular melanoma about six months ago.

Maggie discovered a dark-colored small lump on her upper left back. A biopsy of the lump revealed nodular melanoma. The lump was excised. A left axillary lymph node biopsy revealed residual melanoma in two nodes. A complete lymph node dissection was negative for remaining nodes.

The patient agreed to adjuvant treatment with a CTLA-4 checkpoint inhibitor. Before her 4th dose, she experienced flu-like symptoms and ongoing headaches. A complete workup was performed. She was diagnosed with immune-related meningoencephalomyelitis and treated with steroids.

She relates that she is taking levothyroxine 100 mcg daily for hypothyroidism that is immune-mediated.

Could Maggie’s new symptoms be related to her past diagnosis of immune-related meningoencephalomyelitis?

What is the next step in helping Maggie manage her new symptoms?