Case Report: Bilateral optic disc edema with papillophlebitis-like features following combined cisplatin and capecitabine chemotherapy.

Abstract

Background: Ocular adverse events associated with cisplatin and capecitabine are uncommon, and bilateral optic disc edema with papillophlebitis-like features has rarely been reported. We describe a case of bilateral optic disc edema with papillophlebitis-like features following combined cisplatin and capecitabine chemotherapy in a patient with squamous cell carcinoma of the anal canal. We discuss the differential diagnosis, possible mechanisms, and clinical course in the context of the existing literature.

Case presentation: A 50-year-old woman with squamous cell carcinoma of the anal canal received pelvic radiotherapy (28 fractions) combined with four cycles of cisplatin and oral capecitabine. Sixteen days after the final cycle of chemotherapy, she developed painless bilateral blurred vision. Fundus examination revealed bilateral optic disc edema and hyperemia, peripapillary flame-shaped hemorrhages, and dilated retinal veins. Fundus fluorescein angiography demonstrated leakage from the optic disc vasculature, while optical coherence tomography(OCT) showed bilateral thickening of the peripapillary retinal nerve fiber layer. Comprehensive systemic work-up, including complete blood count, inflammatory markers, tumor markers, a paraneoplastic antibody panel, contrast-enhanced brain magnetic resonance imaging, and multidisciplinary consultation, revealed no alternative systemic, neurologic, or paraneoplastic explanation. Intracranial hypertension, optic neuritis, and non-arteritic anterior ischemic optic neuropathy (NAION) were considered less likely based on the overall clinical findings. No systemic glucocorticoids were administered, and the patient was managed with close observation. At the two-month follow-up, best-corrected visual acuity had improved to 1.2 in both eyes, with complete resolution of the optic disc edema on fundus examination and OCT.

Discussion: The temporal association with chemotherapy, bilateral presentation, papillophlebitis-like fundus findings, and spontaneous resolution after completion of treatment suggest a possible chemotherapy-associated toxic or vascular reaction. Cisplatin-related endothelial toxicity and capecitabine-associated vasospasm may be potential mechanisms. However, a direct causal relationship cannot be established from a single case.