Related Experiment Video
Updated: Jun 13, 2025
Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis
Published on: March 4, 2014
Autonomic dysfunction as manifestation of ICANS: A case report
Dina Rochate1, Antonio Manuel González-García2, Carmen Santos Marcos3
1Hematology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.
Rationale:
Anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy is a successful treatment for B-cell malignancies associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Cardiovascular toxicities have also been reported in this setting. However, there is scarce data regarding development of autonomic disorders after CAR-T cell therapy.
Patient Concerns:
We report a case with a patient with non-Hodgkin B-cell lymphoma, refractory to 2 prior lines of immunochemotherapy, treated with CAR-T therapy.
Diagnoses:
Orthostatic hypotension secondary to autonomic dysfunction was diagnosed as manifestation of ICANS.
Interventions:
The patient received metilprednisolone 1000 mg IV daily for 3 days and anakinra 100 mg IV every 6h.
Outcomes:
The vast majority of autonomic symptoms ceased and 4 months after CAR-T therapy, autonomic dysfunction was resolved.
Lessons:
New-onset autonomic dysfunction can occur as manifestation of ICANS in patients who experience persistent neurologic and cardiovascular symptoms after resolution of acute neurotoxicity and should be early recognized. Differences in differential diagnosis, mechanisms and treatment approaches are discussed.
Related Concept Videos
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...
01:17Irritable Bowel Syndrome I: Introduction
IBS is a chronic condition that can persist over a long period or recur frequently.
The pathogenesis of IBS involves a complex interplay of the following factors:
Altered...
01:30Irritable Bowel Syndrome III: Medical and Nursing Management
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:26Autonomic Nervous System: Overview
01:22Autonomic Nervous System
The ANS comprises two main divisions: the sympathetic and parasympathetic divisions. These divisions function antagonistically to maintain a dynamic...