TY - JOUR
T1 - Eosinophilic Vasculitis and Arteritic Anterior Ischemic Optic Neuropathy Associated with Anti-PD-L1 Therapy
AU - Berry, Ella C.
AU - Mullany, Sean
AU - Quinlivan, Alannah
AU - Craig, Amelia
AU - New-Tolley, Julia
AU - Slattery, James
AU - Sukumaran, Shawgi
AU - Klebe, Sonja
AU - Craig, Jamie E.
AU - Siggs, Owen M.
AU - Wechalekar, Mihir D.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Immune checkpoint inhibitor therapy is frequently associated with immune-related adverse events, which occasionally manifest with visual symptoms. Here, we describe a case of unilateral and sudden-onset painless vision loss in an 82-year-old man with metastatic non-small cell lung cancer receiving immunotherapy with the anti-programmed death-ligand 1 agent atezolizumab. Examination demonstrated a right-sided relative afferent pupillary defect, diffusely swollen optic disc, and delayed choroidal and retinal arterial filling on fundus fluorescein angiography, consistent with an arteritic anterior ischemic optic neuropathy. Histology of an ipsilateral temporal artery biopsy revealed a transmural eosinophilic infiltrate without granulomas, while serology revealed the presence of antineutrophil cytoplasmic antibodies. Peripheral eosinophilia was also noted, which preceded treatment by several months. This report highlights the importance of clinician awareness of immune checkpoint inhibitors and their systemic and ophthalmic complications, which rarely appear to extend to eosinophilic temporal arteritis.
AB - Immune checkpoint inhibitor therapy is frequently associated with immune-related adverse events, which occasionally manifest with visual symptoms. Here, we describe a case of unilateral and sudden-onset painless vision loss in an 82-year-old man with metastatic non-small cell lung cancer receiving immunotherapy with the anti-programmed death-ligand 1 agent atezolizumab. Examination demonstrated a right-sided relative afferent pupillary defect, diffusely swollen optic disc, and delayed choroidal and retinal arterial filling on fundus fluorescein angiography, consistent with an arteritic anterior ischemic optic neuropathy. Histology of an ipsilateral temporal artery biopsy revealed a transmural eosinophilic infiltrate without granulomas, while serology revealed the presence of antineutrophil cytoplasmic antibodies. Peripheral eosinophilia was also noted, which preceded treatment by several months. This report highlights the importance of clinician awareness of immune checkpoint inhibitors and their systemic and ophthalmic complications, which rarely appear to extend to eosinophilic temporal arteritis.
KW - PD-L1
KW - temporal
KW - Eosinophilic vasculitis
KW - Immune checkpoint inhibitor
KW - Anterior ischemic optic neuropathy
KW - Immunotherapy
KW - Programmed cell death 1
KW - Temporal arteritis
KW - Atezolizumab
UR - http://www.scopus.com/inward/record.url?scp=85117823487&partnerID=8YFLogxK
U2 - 10.1097/CJI.0000000000000394
DO - 10.1097/CJI.0000000000000394
M3 - Article
C2 - 34570052
AN - SCOPUS:85117823487
VL - 45
SP - 51
EP - 55
JO - Journal of Immunotherapy
JF - Journal of Immunotherapy
SN - 1524-9557
IS - 1
M1 - e394
ER -