Cisplatin-Induced Toxic Optic Neuropathy in a Patient With Hodgkin's Lymphoma

Hodgkin's lymphoma (HL) is commonly treated with multi-agent chemotherapy, with cisplatin being a key component due to its effectiveness in inducing DNA crosslinking and causing cancer cell death. Despite its therapeutic benefits, cisplatin can lead to serious ocular complications, including a rare but severe condition known as cisplatin-induced toxic optic neuropathy. This condition, while uncommon, has the potential to cause significant and irreversible visual impairment, particularly in pediatric patients, even when cisplatin is administered at standard therapeutic doses. The lack of specific guidelines for ocular monitoring during cisplatin therapy exacerbates the challenge of managing this complication, highlighting the importance of monitoring, early detection and intervention. This case report describes a 16-year-old male pediatric patient with stage IVA HL who was admitted for dexamethasone, high-dose cytarabine, and platinum (DHAP) chemotherapy to treat relapsed disease. He developed sudden, painless bilateral vision loss three days after the discontinuation of the DHAP regimen, which had been stopped due to tumor lysis syndrome and acute kidney failure. The patient presented with severely reduced visual acuity and optic disc swelling in both eyes. Despite receiving high-dose intravenous methylprednisolone, visual improvement was minimal. Unfortunately, the patient did not survive due to disease progression. This case report emphasizes the critical need for careful ocular monitoring and the prompt involvement of ophthalmologists to manage and prevent severe and irreversible ocular complications associated with cisplatin therapy.