SHM Converge Scientific Abstract ePoster Gallery-Keep an Eye Out for Immune Related Adverse Events (Iraes)

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This case report describes a rare ophthalmic immune-related adverse event (IRAE) in a 78-year-old woman with uterine carcinosarcoma treated with pembrolizumab and zoledronic acid. One week after infusion, she developed headache, left orbital swelling, blurry vision, and diplopia. Examination showed chemosis, restricted extraocular movements, and reduced visual acuity. MRI of the brain and orbits demonstrated left orbital cellulitis/proptosis with suspected inflammatory phlegmon but no abscess.<br /><br />Because orbital infection can be dangerous, she was initially treated with broad-spectrum IV antibiotics, but she did not improve. Ophthalmology then favored an inflammatory cause, and IV steroids (Solu-Medrol) were started, leading to significant clinical improvement. Additional workup for other inflammatory and autoimmune causes was largely negative, except for an elevated p-ANCA titer, which raised concern for scleritis or uveitis-related inflammation. She was discharged on a slow steroid taper.<br /><br />The report highlights that pembrolizumab, a PD-1 inhibitor, can cause ocular inflammation such as uveitis or scleritis, though this is uncommon. Zoledronic acid has also been linked to posterior scleritis. The authors emphasize the importance of considering IRAEs in cancer patients who present with unexplained orbitopathy, while also carefully ruling out infection and other serious causes before starting steroids.

Asset Subtitle

Devesh Kumar

Meta Tag

Author List Anu Taylor, Devesh Kumar

Category Clinical Vignettes

Concept Immune-Related Adverse Event

Concept Immunotherapy

Concept Ophthalmic Adverse Event

Concept Orbital Inflammation

Concept Orbital Cellulitis

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Devesh Kumar

Track Adult

Keywords

pembrolizumab

immune-related adverse event

orbital cellulitis

orbital inflammation

scleritis

uveitis

zoledronic acid

uterine carcinosarcoma

corticosteroids

diplopia

Immune-Related Adverse Event

Immunotherapy

Ophthalmic Adverse Event

Orbital Inflammation

Orbital Cellulitis