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Case Reports
. 2022 Sep 14;12(9):1242.
doi: 10.3390/brainsci12091242.

Camrelizumab-Induced Isolate Abducens Neuritis: A Rare Ophthalmic Immune-Related Adverse Events

Yanli Hou  1 , Qiang Su  2 , Simeng Tang  1 , Hongyang Li  1
Affiliations
Case Reports

Camrelizumab-Induced Isolate Abducens Neuritis: A Rare Ophthalmic Immune-Related Adverse Events

Yanli Hou et al. Brain Sci. .

Abstract

Background: Anti-tumor immunotherapy with immune checkpoint inhibitors induces several immune-related adverse events. Camrelizumab-related isolate abducens neuritis is rare.

Case presentation: We report on a 67-year-old man with esophageal cancer who presented with acute-onset isolated right abducens cranial nerve palsy after ten cycles of Camrelizumab treatment. Magnetic resonance imaging examination revealed thickening and post-contrast enhancement at the cisternal segment of the right abducens nerve. The diagnosis was immune-related abducens neuritis caused by Camrelizumab. We put him on oral taper corticoids (methylprednisone) for neuritis treatment without Camrelizumab suspension. One month after treatment, he recovered completely. At the last follow-up, one year after the onset of diplopia, the patient was in good condition without neurological symptom recurrence.

Conclusion: Abducens neuritis is a rare immune-related adverse outcome of Camrelizumab. The present case proves the efficacy and safety of using corticoids in the treatment of abducens neuritis.

Keywords: Camrelizumab; abducens neuritis; case report; immune-related adverse events; immunotherapy.

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Conflict of interest statement

The authors declare no conflict of interest. Authors declare no personal circumstances or interests that may be perceived as inappropriately influencing the representation or interpretation of reported research results. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
(A) The right eye does not abduct when gazing in the right direction. The HESS screen test on the onset days (B), one week (C), and one month (D) after corticoid treatment. T: temporal, N: Nasal.
Figure 2
Figure 2
Post-contrast Axial T1WI. There is marked enhancement and thickening of the right abducens nerve (right arrow).
Figure 3
Figure 3
18F-FDG-PET of the patient. (A) Esophageal cancer (after treatment): High accumulation in the middle-lower esophageal section with a maximum SUV of 3.8. (B) Lymph node metastasis: High accumulation in the mediastinum lymph node (region 2R 1.8 cm × 2.2 cm) with a maximum SUV of 17.8.
Figure 4
Figure 4
Immunohistochemistry result of tumor cells (40 × 10): CK7(+).
Figure 5
Figure 5
A detailed clinical timeline is displayed. In March 2020, the patient was hospitalized. After a series of examinations, the patient was diagnosed with middle-lower section esophageal cancer with lymph node metastasis. In March 2020, the patient was started on a chemotherapy regimen containing paclitaxel/carboplatin for four cycles. The regimen was subsequently switched to Cisplatin for three cycles. From September 2020, Camrelizumab was arranged in ten cycles with or without the combination of chemotherapy. The horizontal diplopia was onset in April 2021.
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