A case report of clonal EBV-like memory CD4+ T cell activation in fatal checkpoint inhibitor- induced encephalitis

Johnson DB1,2, McDonnell WJ3,4,5,6,7, Gonzalez-Ericsson PI8, Al-Rohil RN5,9, Mobley BC5, Salem JE3,10, Wang DY3, Sanchez V5, Wang Y11, Chastain CA3, Barker K12, Liang Y12, Warren S12, Beechem JM12, Menzies AM13,14,15,16, Tio M13, Long GV13,14,15,16, Cohen JV17, Guidon AC17, O'Hare M17, Chandra S18, Chowdhary A18, Lebrun-Vignes B10, Goldinger SM19, Rushing EJ20, Buchbinder EI21, Mallal SA3,4,5,6,22, Shi C5, Xu Y11, Moslehi JJ3, Sanders ME5, Sosman JA23, Balko JM24,25,26,27; 1 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. douglas.b.johnson@vumc.org. 2 Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA. douglas.b.johnson@vumc.org. 3 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 4 Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA. 5 Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. 6 Center for Translational Immunology and Infectious Disease, Vanderbilt University Medical Center, Nashville, TN, USA. 7 Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA. 8 Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, TN, USA. 9 Department of Pathology and Dermatology, Duke University Medical Center, Durham, NC, USA. 10 Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France. 11 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA. 12 NanoString Technologies, Seattle, WA, USA. 13 Melanoma Institute Australia, Sydney, Australia. 14 The University of Sydney, Sydney, New South Wales, Australia. 15 Royal North Shore Hospital, Sydney, New South Wales, Australia. 16 Mater Hospital, Sydney, New South Wales, Australia. 17 Massachusetts General Hospital, Boston, MA, USA. 18 Feinberg School of Medicine, Northwestern University, Evanston, IL, USA. 19 Department of Dermatology, University Hospital, Zurich, Switzerland. 20 Institute of Neuropathology, University Hospital, Zurich, Switzerland. 21 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. 22 Institute for Immunology and Infectious Diseases, Perth, Australia. 23 Northwestern Feinberg School of Medicine, Chicago, IL, USA. 24 Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. justin.balko@vumc.org. 25 Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, TN, USA. justin.balko@vumc.org. 26 Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. justin.balko@vumc.org. 27 Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, TN, USA. justin.balko@vumc.org.