Abstract
BackgroundIpilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma. While ipilimumab provides an overall survival benefit to patients, it can be associated with immune related adverse events (IrAEs).Case presentationHere we describe a patient treated with ipilimumab who experienced known IrAEs, including hypophysitis, as well as a profound vision loss due to optic neuritis. There are rare reports of optic neuritis occurring as an adverse event associated with ipilimumab treatment. Furthermore, the patient experienced multiple complications from high dose steroids used to manage his IrAEs.ConclusionsThis case highlights the need for recognition of atypical immune mediated processes associated with newer checkpoint inhibitor therapies including ipilimumab.
Highlights
BackgroundThere were limited treatment options for patients with advanced stage melanoma
Ipilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma
We report here a patient who demonstrated multiple immune-related adverse events including panhypopituitarism and optic neuritis, resulting in monocular blindness, after undergoing treatment with ipilimumab
Summary
There were limited treatment options for patients with advanced stage melanoma. Fifteen months after the initiation of ipilimumab, he was clinically stable on mycophenolate mofetil and a slow prednisone taper; his ophthalmologic examination was notable for visual acuities of 20/20 in the right eye, and no light perception in the left eye; the right optic disc swelling had resolved, and the left optic nerve remained atrophic He was again intolerant of further steroid taper with recurrent right eye blurred vision prompting hospital readmission and another course of intravenous methylprednisolone 250 mg every 6 h. A lumbar puncture performed during this hospital stay was negative for malignancy or infection and he was discharged on mycophenolate mofetil 1000 mg twice daily and prednisone 80 mg daily (Table 1) At this time, his metastatic melanoma was slowly progressing with increasing lymphadenopathy and his visual acuity ranged from 20/20 to 20/40 in the right eye, and no light perception in the left eye. Comfort measures were initiated and the patient passed away shortly afterward
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