Abstract

Purpose

To report a case of isolated optic neuritis associated with pembrolizumab immunotherapy for metastatic non-small cell lung carcinoma.

Case presentation

A 76-year-old man, with a history of metastatic non-small cell lung carcinoma, presented with vision loss in his left eye for the past week. He had been treated with pembrolizumab for the underlying disease for 2 months. On presentation, best corrected visual acuity was 20/30 in the right eye and 20/200 in the left eye. Fundoscopy revealed optic nerve edema in the left eye. Visual fields examination in right eye revealed an enlarged blind spot and an extended defect in the inferior nasal quadrant. In the left eye a partial superior arcuate defect and an extended defect in the inferior hemisphere was observed. The mean deviation was −12.15 dB in the right eye and −13.70 dB in left eye. Pembrolizumab was withheld and corticosteroids were administered for a total of nine weeks, first intravenously and then slowly tapered orally, resulting in resolution of optic neuritis, restoration of visual acuity and in relative improvement in the visual field defects after 3 months. Calculated Naranjo Nomogram score was 7, indicating a ‘highly probable’ correlation.

Conclusions

Optic neuritis is a relatively rare immune-related adverse event after exposure to checkpoint inhibitors cancer immunotherapy. Prompt discontinuation of the offending agent and early initiation of corticosteroid therapy is the mainstay of the treatment.

中文翻译：

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派姆单抗治疗非小细胞肺癌后孤立性视神经炎

摘要

目的

报告一例与帕博利珠单抗免疫治疗相关的孤立性视神经炎治疗转移性非小细胞肺癌。

案例展示

一名 76 岁男性，有转移性非小细胞肺癌病史，过去一周左眼视力下降。他因基础疾病接受了派姆单抗治疗 2 个月。就诊时，最佳矫正视力右眼为 20/30，左眼为 20/200。眼底镜检查显示左眼视神经水肿。右眼视野检查发现下鼻象限扩大盲点和扩大缺损。在左眼观察到部分上弓形缺损和下半球扩展缺损。右眼的平均偏差为-12.15 dB，左眼的平均偏差为-13.70 dB。停止使用 Pembrolizumab 并使用皮质类固醇总共九周，首先是静脉注射，然后逐渐逐渐减少口服，导致视神经炎消退，视力恢复，3 个月后视野缺损相对改善。计算出的 Naranjo Nomogram 得分为 7，表明“极可能”相关。

结论

在接受检查点抑制剂癌症免疫治疗后，视神经炎是一种相对罕见的免疫相关不良事件。及时停用致病药物和早期开始皮质类固醇治疗是治疗的主要方法。