A case of severe visual loss related to treatment with pembrolizumab for metastatic renal pelvic cancer

Q4 Medicine

IJU Case Reports Pub Date : 2024-09-06 DOI:10.1002/iju5.12784

Naoki Inoue, Mihoko Iitzuka, Hiroki Tanaka, Yudai Ishikawa, Naoko Kawamura, Tetsuo Okuno

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Abstract

Introduction

Pembrolizumab is the standard therapy for urothelial carcinoma treatment; however, adverse events have been noted. Here, we report a rare case of vision loss as an immune-related adverse event of pembrolizumab therapy in a patient with metastatic renal pelvic cancer.

Case presentation

A 69-year-old man treated with pembrolizumab for lung and lymph node metastases of renal pelvic cancer experienced significant vision loss in both eyes after 11 treatment cycles. Without magnetic resonance imaging confirmation owing to an MRI-unsafe pacemaker, his clinical features suggested immune checkpoint inhibitor-associated optic neuritis. Pembrolizumab was discontinued, and the patient received steroid pulse and immunoglobulin therapy. His vision in the right eye improved, but that in the left eye remained unchanged. He maintained a partial response for 36 months despite pembrolizumab discontinuation.

Conclusion

Despite its rarity, vision loss is a potential irAE in patients treated with ICIs, including pembrolizumab.

Abstract Image

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一例因使用 Pembrolizumab 治疗转移性肾盂癌而导致严重视力丧失的病例。

简介Pembrolizumab 是治疗尿路上皮癌的标准疗法；然而，不良事件也时有发生。在此，我们报告了一例罕见的视力丧失病例，这是转移性肾盂癌患者在接受 Pembrolizumab 治疗时发生的免疫相关不良事件：一名 69 岁的男性患者因肾盂癌肺部和淋巴结转移接受了 pembrolizumab 治疗，在接受了 11 个治疗周期后出现双眼视力明显下降。由于安装了核磁共振不安全起搏器，他没有得到核磁共振成像确认，但其临床特征提示为免疫检查点抑制剂相关性视神经炎。患者停用了 Pembrolizumab，并接受了类固醇脉冲和免疫球蛋白治疗。他的右眼视力有所改善，但左眼视力仍无变化。尽管停用了pembrolizumab，他的部分反应仍维持了36个月：尽管罕见，但视力下降是接受 ICIs（包括 pembrolizumab）治疗的患者的潜在 irAE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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