Devine Intervention
| Identifier | walsh_2024_s3_c4 |
| Title | Devine Intervention |
| Creator | Letitia Pirau; Wayne Cornblath; Lindsey De Lott; Sangeeta Khanna; Tatiana Deveney |
| Affiliation | (LP) (WC) (LD) (SK) (TD) University of Michigan |
| Subject | Optic Chiasm; Optic Neuritis; Magnetic Resonance Imaging (MRI) |
| Description | A 30 yo woman presented to the comprehensive ophthalmology clinic with bilateral decreased vision. She had no prior ocular history. Her medical history was notable for breast cancer (diagnosed 1 year prior), treated with radiation, chemotherapy, lumpectomy, and pembrolizumab (completed 8/9 planned infusions). She described progressive vision loss in both eyes over the 2 weeks with light sensitivity, pain with eye movements, and diminished color vision. Her best corrected visual acuity was 20/500 in the right eye and count fingers at 3' in the left eye. No APD. Confrontation visual fields were notable for dense constriction in the right eye and temporal field loss in the left eye. The dilated funduscopic exam was normal. She was sent to the emergency department for an expedited work-up. MRI brain and orbits with and without contrast revealed T2 signal and enhancement along the optic chiasm, tracts, and prechiasmatic optic nerves (radiology images 1-4 ). There was no evidence of demyelinating lesions. Lumbar puncture and CT chest/abdomen/pelvis were unremarkable with no metastatic or systemic inflammatory process identified. A diagnostic procedure was performed. |
| History | A 30 yo woman presented to the comprehensive ophthalmology clinic with bilateral decreased vision. She had no prior ocular history. Her medical history was notable for breast cancer (diagnosed 1 year prior), treated with radiation, chemotherapy, lumpectomy, and pembrolizumab (completed 8/9 planned infusions). She described progressive vision loss in both eyes over the 2 weeks with light sensitivity, pain with eye movements, and diminished color vision. Her best corrected visual acuity was 20/500 in the right eye and count fingers at 3' in the left eye. No APD. Confrontation visual fields were notable for dense constriction in the right eye and temporal field loss in the left eye. The dilated funduscopic exam was normal. She was sent to the emergency department for an expedited work-up. MRI brain and orbits with and without contrast revealed T2 signal and enhancement along the optic chiasm, tracts, and prechiasmatic optic nerves (radiology images 1-4 ). There was no evidence of demyelinating lesions. Lumbar puncture and CT chest/abdomen/pelvis were unremarkable with no metastatic or systemic inflammatory process identified. A diagnostic procedure was performed. |
| Disease/Diagnosis | Neuromyelitis Optica Spectrum Disorder After Pembrolizumab Treatment (In The Setting of Breast Cancer) |
| Date | 2024-03 |
| References | Hirano, S., Kojima, A., Nakayama, Y., Takeda, T., Kishimoto, T., Takahashi, T., Kuwabara, S., & Mori, M. (2022). A case report of neuromyelitis optica spectrum disorder induced by pembrolizumab treatment for lung adenocarcinoma: A clinical and immunohistochemical study. BMC Neurology, 22(1). https://doi.org/10.1186/s12883-022-02987-6, Nasralla, S., & Abboud, H. (2020). Is neuromyelitis optica without AQP4-IGG a T-cell-mediated disease? insights from checkpoint inhibitor immune-related adverse events. Multiple Sclerosis and Related Disorders, 46, 102451. https://doi.org/10.1016/j.msard.2020.102451, Wilson, R., Menassa, D. A., Davies, A. J., Michael, S., Hester, J., Kuker, W., Collins, G. P., Cossins, J., Beeson, D., Steven, N., Maddison, P., Rinaldi, S., Jacob, S., & Irani, S. R. (2018). Seronegative antibody-mediated neurology after immune checkpoint inhibitors. Annals of Clinical and Translational Neurology, 5(5), 640-645. https://doi.org/10.1002/acn3.547. Vargas Pivato de Almeida, D. (2022). Neurological toxic effects associated with treatment with immune checkpoint inhibitors-are we really safer now? JAMA Network Open, 5(4). https://doi.org/10.1001/jamanetworkopen.2022.7731 Wingerchuk DM;Banwell B;Bennett JL;Cabre P;Carroll W;Chitnis T;de Seze J;Fujihara K;Greenberg B;Jacob A;Jarius S;Lana-Peixoto M;Levy M;Simon JH;Tenembaum S;Traboulsee AL;Waters P;Wellik KE;Weinshenker BG; ; (n.d.). International consensus diagnostic criteria for Neuromyelitis Optica Spectrum Disorders. Neurology. https://pubmed.ncbi.nlm.nih.gov/26092914/ Yu, C. W., Yau, M., Mezey, N., Joarder, I., & Micieli, J. A. (2020, November 3). Neuro-ophthalmic complications of immune checkpoint inhibitors: A systematic review. Eye and brain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648547/ Carrillo, P., Gorría, T., Santana, D., Sepulveda, M., Aldecoa, I., Gonzalez-Farré, B., Sanfeliu, E., Mension, E., Cebrecos, I., Martínez-Saez, O., Alonso, I., & Saiz, A. (2022). Aquaporin-4-positive triple-negative breast cancer presenting with paraneoplastic neuromyelitis Optica Spectrum disorder. Biomedicine Hub, 7(1), 11-16. https://doi.org/10.1159/000521578 Haanen J;Obeid M;Spain L;Carbonnel F;Wang Y;Robert C;Lyon AR;Wick W;Kostine M;Peters S;Jordan K;Larkin J; ; (n.d.). Management of toxicities from immunotherapy: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Annals of oncology : official journal of the European Society for Medical Oncology. https://pubmed.ncbi.nlm.nih.gov/36270461/ Daetwyler, E., Zippelius, A., Meyer, P., & Läubli, H. (2023). Pembrolizumabinduced optic neuropathy - A case report. Frontiers in Immunology, 14. https://doi.org/10.3389/fimmu.2023.1171981 |
| Language | eng |
| Format | video/mp4 |
| Type | Image/MovingImage |
| Source | 2024 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of | NANOS Annual Meeting 2024 |
| Collection | Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher | North American Neuro-Ophthalmology Society |
| Holding Institution | Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management | Copyright 2024. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK | ark:/87278/s6k2yjne |
| Setname | ehsl_novel_fbw |
| ID | 2592827 |
| Reference URL | https://collections.lib.utah.edu/ark:/87278/s6k2yjne |