Recurrent audiovestibular dysfunction and associated neurological immune-related adverse events in a melanoma patient treated with nivolumab and ipilimumab.
hearing loss
immunotherapy
melanoma
neurological immune-related adverse events
ototoxicity
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
01
07
2020
accepted:
24
08
2020
pubmed:
6
9
2020
medline:
22
6
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
Recurrent immunotherapy-induced audiovestibular toxicity despite cessation of therapy has not been reported. We report the first case of recurrent audiovestibular toxicity following immune-checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune-related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab. Audiogram 8 months following the last recurrence showed hearing improvement and stability. Immunotherapy-induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.
Sections du résumé
BACKGROUND
Recurrent immunotherapy-induced audiovestibular toxicity despite cessation of therapy has not been reported.
METHODS
We report the first case of recurrent audiovestibular toxicity following immune-checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune-related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab.
RESULTS
Audiogram 8 months following the last recurrence showed hearing improvement and stability.
CONCLUSION
Immunotherapy-induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.
Substances chimiques
Antineoplastic Agents, Immunological
0
Ipilimumab
0
Nivolumab
31YO63LBSN
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
E35-E42Informations de copyright
© 2020 Wiley Periodicals LLC.
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