Journal
HEMATOLOGY REPORTS
Volume 15, Issue 1, Pages 1-8Publisher
MDPI
DOI: 10.3390/hematolrep15010001
Keywords
immune effector cell-associated neurotoxicity syndrome; CAR-T cell therapy; ocular ultrasound; cancer therapy
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Bedside sonographic measurement of optic nerve sheath diameter is helpful in diagnosing elevated intracranial pressure, and proved valuable in a case of immune effector cell-associated neurotoxicity syndrome. The patient showed wide optic nerve sheath diameters and bulging optic discs bilaterally. Prompt treatment resulted in a successful recovery with no long-term neurological deficits.
Usually used in emergency settings, bedside sonographic measurement of optic nerve sheath diameter can aid in diagnosing elevated intracranial pressure. We report a case of a 26-year-old male hospitalized for CAR T-cell therapy with Axicabtagene Ciloleucel for treatment of relapsed diffuse large B-cell lymphoma, who developed progressive symptoms of immune effector cell-associated neurotoxicity syndrome. Fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. The patient had a ventriculostomy placed for monitoring and received treatment with steroids and mannitol, as well as tocilizumab. After 7 days in the ICU, the patient recovered with no evidence of long-term neurological deficits.
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