[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-452863-105":59,"doc-detail-452863-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","multiple-cranial-neuropathies-after-lenvatinibpembrolizumab-therapy-for-metastatic-renal-cell-carcinoma-a-case-report","Multiple Cranial Neuropathies After Lenvatinib–Pembrolizumab Therapy for Metastatic Renal Cell Carcinoma - A Case Report","","Multiple cranial neuropathy is a rare immune-related adverse event (irAE) and has not previously been reported during immune checkpoint blockade for metastatic renal cell carcinoma. This case report details a 66-year-old man treated with lenvatinib plus pembrolizumab who developed rash and facial nerve palsy after two months, improving with corticosteroids. Pembrolizumab rechallenge later caused diplopia from multiple cranial neuropathies, which improved after steroid pulse therapy. Two years after treatment initiation, disease control and pembrolizumab maintenance continued without neurological recurrence, emphasizing early occurrence and steroid responsiveness.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/multiple-cranial-neuropathies-after-lenvatinibpembrolizumab-therapy-for-metastatic-renal-cell-carcinoma-a-case-report/452863/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/multiple-cranial-neuropathies-after-lenvatinibpembrolizumab-therapy-for-metastatic-renal-cell-carcinoma-a-case-report/452863.png","ImageObject",300,407,{"name":92,"@type":93},"moss~","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What treatment was associated with the onset of the cranial neuropathies in this case?","Question",{"text":112,"@type":113},"The patient developed multiple cranial neuropathies during combination therapy with lenvatinib and pembrolizumab for metastatic renal cell carcinoma.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the patient respond to corticosteroid therapy?",{"text":117,"@type":113},"Initial symptoms, including facial nerve palsy, resolved with corticosteroids. After rechallenge caused recurrent neurologic symptoms with diplopia, steroid pulse therapy improved the condition.",{"name":119,"@type":110,"acceptedAnswer":120},"What was the patient’s neurological status after long-term follow-up?",{"text":121,"@type":113},"Two years after treatment initiation, disease control and pembrolizumab maintenance continued without neurological recurrence.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},452863,1790901432,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},962090895452,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","IJU Case Reports  \n CASE REPORT  OPEN ACCESS   \nMultiple Cranial Neuropathies After Lenvatinib–Pembrolizumab Therapy for Metastatic Renal Cell Carcinoma: A Case Report  \nHideyuki Minagawa1 | Tomoyuki Kaneko1 | Keiichi Hokkoku2 | Ayano Miyashima3 | Inoue Hazuki1 | Ono Tenei1 | Risako Yagi1 | Kenjiro Kishitani1 | Kazuki Takei1 | Tohru Nakagawa1  \n1Department of Urology, Teikyo University School of Medicine, Tokyo, Japan | 2Department of Neurology, Teikyo University School of Medicine, Tokyo,  \nJapan | 3Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan Correspondence: Tomoyuki Kaneko ([kanekot@med.teikyo-u.ac.jp](kanekot@med.teikyo-u.ac.jp))  \nReceived: 25 October 2025 | Revised: 2 December 2025 | Accepted: 29 December 2025  \nKeywords: cranial neuropathy | immune-related adverse event | lenvatinib | pembrolizumab | renal cell carcinoma  \nABSTRACT  \nIntroduction: Multiple cranial neuropathy is a rare manifestation of immune-related adverse events. To date, no cases have been reported during immune checkpoint blockade for metastatic renal cell carcinoma. This report describes a case of multiple cranial neuropathy that developed during lenvatinib and pembrolizumab combination therapy.  \nCase Presentation: A 66-year-old man with metastatic clear cell renal cell carcinoma involving the maxilla received lenvatinib and pembrolizumab. After two months, he developed a rash and facial nerve palsy that resolved with corticosteroids. Pembrolizumab rechallenge later caused diplopia due to multiple cranial neuropathies, which improved after steroid pulse therapy. Two years after treatment initiation, disease control and pembrolizumab maintenance have continued without neurological recurrence.  \nConclusions: We report a rare case of multiple cranial nerve palsies that developed during lenvatinib–pembrolizumab therapy. Such neuropathies typically occur early, respond to corticosteroids, and require careful monitoring, as retreatment may lead to recurrence or new adverse events.  \n1 | Introduction  \nTwelve pairs of cranial nerves occur that innervate most head and neck structures. Their fibers traverse the meninges, subarachnoid space, skull base, and soft tissues; dysfunction along these pathways can cause cranial nerve symptoms. Multiple cranial neuropathy, defined as the involvement of two or more cranial nerves, is most commonly caused by tumors, cerebrovascular disease, or head trauma [1, 2] . In a review of 979 cases, the abducens nerve was most frequently affected, followed by  \nthe facial, oculomotor, and trigeminal nerves [1] . Reported etiologies include infectious, inflammatory, neoplastic, vascular, toxic, and traumatic disorders [2] .  \nImmune checkpoint inhibitors (ICIs) have improved survival in several malignancies, and combination regimens are now standard first-line therapy for metastatic renal cell carcinoma (RCC)[3–6] . By blocking immune checkpoints, such as programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4), ICIs restore antitumor immunity but  \n\n| Abbreviations: ANCA, Antineutrophil cytoplasmic antibody; CT, Computed tomography; CTLA-4, Cytotoxic T-lymphocyte–associated antigen 4; ICI, Immune checkpoint inhibitor; irAEs, Immune-related adverse events; IVIg, Intravenous immunoglobulin; PD-1, Programmed cell death protein 1; PD-L1, Programmed death-ligand 1; PLEX, Plasma exchange; RCC, Renal cell carcinoma. |\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.\u003Cbr>© 2026 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association. |\n\nIJU Case Reports, 2026; 9:e70136 1 of 4  \n[https://doi.org/10.1002/iju5.70136](https://doi.org/10.1002/iju5.70136)  \nKeynot","cbCaij2v5F6R8WIx","https://ap.wps.com/l/cbCaij2v5F6R8WIx","pdf",656297,"English","# Introduction\n## Case Presentation\n## Conclusions","[{\"question\":\"What treatment was associated with the onset of the cranial neuropathies in this case?\",\"answer\":\"The patient developed multiple cranial neuropathies during combination therapy with lenvatinib and pembrolizumab for metastatic renal cell carcinoma.\"},{\"question\":\"How did the patient respond to corticosteroid therapy?\",\"answer\":\"Initial symptoms, including facial nerve palsy, resolved with corticosteroids. After rechallenge caused recurrent neurologic symptoms with diplopia, steroid pulse therapy improved the condition.\"},{\"question\":\"What was the patient’s neurological status after long-term follow-up?\",\"answer\":\"Two years after treatment initiation, disease control and pembrolizumab maintenance continued without neurological recurrence.\"}]","Multiple Cranial Neuropathies After Lenvatinib–Pembrolizumab Therapy for Metastatic Renal Cell Carcinoma - A Case Report | PDF",1790737787]