Division of Medical Oncology, University Hospital Basel, Basel, Switzerland.
Department of Biomedicine, University of Basel, Basel, Switzerland.
Front Immunol. 2023 May 9;14:1171981. doi: 10.3389/fimmu.2023.1171981. eCollection 2023.
Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including Hodgkin's lymphoma. However, ICI can overstimulate the immune system, leading to a broad range of immunological side effects, known as immune-related adverse events (irAEs). Here, we report a case of optic neuropathy caused by pembrolizumab.
A patient with Hodgkin's lymphoma received pembrolizumab every three weeks. Twelve days after the sixth cycle of pembrolizumab, the patient was admitted to the emergency department with blurred vision, visual field impairment and altered color perception affecting the right eye. The diagnosis of immune-related optic neuropathy was established. Pembrolizumab was stopped permanently and high-dose steroid treatment was immediately started. This emergency treatment led to a satisfactory binocular vision and an improvement of visual acuity testing results. After another 7 months, the left eye was affected with the same symptoms. At this time, only an extended immunosuppressive therapy consisting of high-dose steroid treatment, plasmapheresis, immunoglobulin treatment, retrobulbar injection of steroids and mycophenolate mofetil, successfully reduced the symptoms.
This case highlights the need for prompt recognition and treatment of rare irAEs, such as optic neuropathy. Urgent treatment with initial high-dose steroid treatment is required to avoid persistent loss of visual acuity. Options for further treatment are mainly based on small case series and case reports. In our case, a retrobulbar injection of steroids in combination with mycophenolate mofetil showed significant success in treating steroid-refractory optic neuropathy.
免疫检查点抑制剂（ICI）治疗已成为治疗各种癌症类型的重要手段，包括霍奇金淋巴瘤。然而，ICI 可能会过度刺激免疫系统，导致广泛的免疫相关副作用，称为免疫相关不良事件（irAEs）。在这里，我们报告一例由 pembrolizumab 引起的视神经病变。
一名霍奇金淋巴瘤患者每三周接受一次 pembrolizumab 治疗。在第六周期 pembrolizumab 治疗后 12 天，患者因视力模糊、视野损害和影响右眼色觉改变而被收入急诊部。诊断为免疫相关性视神经病变。永久停止 pembrolizumab 治疗，并立即开始大剂量类固醇治疗。这种紧急治疗导致双眼视力满意，视力测试结果改善。7 个月后，左眼出现相同症状。此时，仅延长免疫抑制治疗，包括大剂量类固醇治疗、血浆置换、免疫球蛋白治疗、球后注射类固醇和霉酚酸酯，成功缓解症状。
本例强调了需要及时识别和治疗罕见的 irAEs，如视神经病变。需要初始大剂量类固醇治疗来避免持续性视力丧失。进一步治疗的选择主要基于小病例系列和病例报告。在我们的病例中，球后注射类固醇联合霉酚酸酯在治疗类固醇难治性视神经病变方面取得了显著成功。
