Sudden bilateral cochleovestibulopathy in a patient with Anti-PD-L1 antibody treatment for metastatic non-small cell lung cancer

Background Bilateral Cochleovestibulopathy is a rare condition and in a sudden onset, it hugely affects the patients and their quality of life. There are uncommon differential diagnoses that have to be considered, one of them is meningeosis carcinomatosa.

Material and Methods We present a case of sudden bilateral cochleovestibulopathy in a 64-year-old female patient who presented in the emergeny department at a tertiary referral center because of sudden-onset vertigo and bilateral hearing loss as well as a facial nerve paralysis. Medical history, clinical examination and functional diagnostic findings are shown.

Results The patient presented with rotational vertigo and sudden bilateral hearing loss. She reported about non-small cell lung cancer, which was diagnosed one year before and was treated with the Anti-PD-L1 antibody Atezolizumab at the time of presentation. Clinical findings revealed spontaneous nystagmus III° to the left as well as a pathologic vestibulo-ocular reflex on both sides. Pure-tone audiometry confirmed bilateral profound hearing loss with residual deep tone hearing. Bilateral vestibular loss was confirmed with Video Head Impulse Test. cMRI showed bilateral enhancement of the vestibulocochlear nerve. Meningeosis carcinomatosa was later confirmed by a CSF sample. Treatment was conducted with prednisone tapering scheme.

Conclusion Sudden bilateral cochleovestibulopathy is a very rare condition, which can be caused by meningeosis carcinomatosa. Another cause and differential diagnosis might be the antibody treatment with Atezolizumab.

Publication History

Article published online:
12 May 2023