Treatments for paraneoplastic
optic neuropathy (PON), a
tumor-related
autoimmune disease, include immunosuppression,
plasma exchange, and
immunoglobulin therapies, as well as treatment of the underlying disease. Herein, we describe the
clinical course of an older adult patient with PON whose loss of vision improved after switching between
epidermal growth factor receptor-
tyrosine kinase inhibitor (EGFR-TKI) treatments for
cancer. A 76-year-old woman, who had been treated with
gefitinib for
lung adenocarcinoma for two years, presented with acute bilateral visual disturbances. Her decimal best-corrected visual acuity (BCVA) was 0.3 in the right eye (RE) and 0.7 in the left eye (LE).
Slit-lamp examination and funduscopy showed no abnormal findings. Two weeks later, her BCVA decreased to 0.2 in the RE and 0.01 in the LE. Goldman's perimetry showed a defect in the lower nasal RE and extensive visual-field loss in the LE. Single-flash electroretinograms showed normal amplitudes. Magnetic resonance imaging revealed left
optic neuritis and showed neither metastatic
cancer nor
multiple sclerosis. Pattern-reversal visual evoked potentials showed decreased P100 amplitudes in both eyes (BE). Based on a diagnosis of PON from clinical findings,
methylprednisolone pulse treatment was administered. However, her BCVA became no light perception in BE two months after the first visit. Because the
tumor tissue was found to be positive for the EGFR T790M resistance mutation by bronchoscopy, the EGFR-TKI treatment was changed to
osimertinib, decreasing the size of the
lung cancer lesions. Her BCVA improved to hand motion in BE. Her final BCVA was 0.01 in the RE, counting fingers 10 cm in the LE. She died at the age of 79 years. To our knowledge, no reports have shown improvement in BCVA in patients with PON after changing EGFR-TKI treatments. This report indicates that some patients may develop severe visual dysfunction without early treatment for the primary
tumor.