Optic Perineuritis Associated with Nivolumab Treatment for Non-Small Cell Lung Cancer

Abstract

We report the case of a 54-year-old man who was treated with nivolumab for recurrent squamous cell lung cancer. After 7 cycles of nivolumab treatment, the patient presented to our hospital with right eye vision loss. Gadolinium-enhanced magnetic resonance imaging of the brain showed enhancement around the optic nerve sheath. This finding and his symptoms led to the diagnosis of optic perineuritis (OPN). Steroid pulse therapy was administered twice although there was no remarkable improvement in his visual field defect. The relationship between OPN and nivolumab is unclear. However, immune-related adverse events caused by immune checkpoint inhibitors should be considered.

Delayed-Onset Inflammatory Optic Nerve Sheath Mass and Perineuritis Following Cessation of Ipilimumab and Nivolumab Therapy

“…8 While on-treatment optic perineuritis has previously been associated with immune checkpoint inhibitor therapy, our case represents the first report, to our knowledge, of delayed-onset optic perineuritis with an inflammatory nerve sheath mass following cessation of immunotherapy; the irAE occurred 2 years and 3 months after discontinuation of ipilimumab and nivolumab therapy, respectively. 9 While it is plausible that the patient’s orbital inflammation was unrelated to prior immunotherapy, his optic nerve sheath mass and perineuritis—like other reported sequelae of on-treatment irAE—responded favorably to corticosteroid therapy, and a thorough work-up for alternative etiologies was unrevealing.…”

The crucial role of gadolinium-enhanced MRI in a case of amaurosis fugax – a case report and literature review

“…The etiology for secondary OPN includes inflammatory, autoimmune and connective tissue diseases (giant cell arteritis, Graves' disease, immunoglobulin G4-related disease, granulomatosis with polyangiitis, systemic lupus erythematosus, sarcoidosis, rheumatoid arthritis, Sjogren's syndrome, scleroderma, Behcet's disease, gout, Crohn's disease [2,5,25,26]), infections (syphilis, tuberculosis, mycoplasma pneumoniae, ocular toxoplasmosis, bacterial or fungal meningitis, sparganosis, cytomegalovirus, herpes zoster, COVID-19 [1,5,20,27]) or neoplasia (acute leukemia, primary or metastatic malignancies [1,25]). Furthermore, OPN after post-influenza vaccination [28] or induced by checkpoint inhibitors used for non-small cell lung cancer [6] was reported. It is important to mention that there are some reports that describe OPN cases associated with anti-myelin oligodendrocyte glycoprotein (MOG) antibodies [5,29,30].…”

“…This aspect produces the "tram-track" sign on axial imaging and the "doughnut" sign on coronal imaging [1]. OPN is usually idiopathic, but infections, autoimmune diseases, neoplasia or drugs can cause secondary OPN [1,5,6]. Treatment consists in steroid therapy in high doses with rapid improvement of the clinical features [1], though spontaneous resolution of the disease has been reported [7,8].…”