Autoimmune encephalitis causes subacute deficits of memory and cognition, often followed by suppressed level of consciousness or coma. Checkpoint inhibition is the mainstay of treatment in metastatic melanoma. More recently combination of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed-death-1 (PD-1) blockade has resulted in improved response rates and overall survival in treatment naïve patients. Neurological toxicities are an emerging consequence of the use of checkpoint inhibitors.

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... e are here to present a case of neurotoxicity from the use of immunotherapy. Case Report: A 63-year-old female with metastatic melanoma to brain and breast presented to the emergency department with altered mental status. She was disoriented to time and place and unable to follow commands. She had received two doses of immunotherapy with ipilimumab and nivolumab. Her last dose was administered two weeks prior. She developed low grade fever and fatigue over the past week prompting evaluation by her local oncologist who prescribed her sulfamethoxazole-trimethoprim for possible urinary tract infection. She never picked up the prescription and two days later she went to an urgent care for worsening lethargy and fever. An infectious