Pembrolizumab-induced optic neuropathy - a case report.

Area of Science:

• Oncology
• Immunology
• Neuro-ophthalmology

Background:

• Immune checkpoint inhibitors (ICIs) are vital in cancer therapy, including Hodgkin's lymphoma.
• ICIs can trigger immune-related adverse events (irAEs) due to immune system overstimulation.
• Optic neuropathy is a rare but serious irAE associated with ICI treatment.

Observation:

• A Hodgkin's lymphoma patient developed optic neuropathy after pembrolizumab treatment.
• Initial symptoms included blurred vision, visual field defects, and color perception changes in the right eye.
• The left eye was later affected, indicating a potential for bilateral involvement.

Findings:

• High-dose steroid therapy led to initial visual improvement.
• Persistent symptoms required advanced immunosuppressive treatment, including plasmapheresis, IVIg, retrobulbar steroid injection, and mycophenolate mofetil.
• Combination therapy with retrobulbar steroids and mycophenolate mofetil proved effective for steroid-refractory optic neuropathy.

Implications:

• Early recognition and intervention are critical for managing ICI-induced optic neuropathy.
• Prompt high-dose steroid treatment can prevent irreversible vision loss.
• Multimodal immunosuppressive strategies may be necessary for severe or refractory cases.