Sudden Deafness and Vestibulopathy in a Patient with Antibody Treatment for Metastatic Lung Cancer

We describe the case of a patient who presented with sudden onset vertigo and bilateral deafness while under immune checkpoint therapy for metastatic bronchial carcinoma. Extensive audiologic assessment and vestibular function testing, as well as cranial magnetic resonance imaging (cMRI) and lumbar puncture was performed. The diagnostic workup confirmed bilateral sensorineural deafness and bilateral loss of vestibular function, while imaging revealed enhancement of the vestibulocochlear nerve. Initially, immunotherapy with PD-L1 antibody atezolizumab was the assumed cause of the described symptoms. However, further findings strengthened the suspicion of meningeosis neoplastica. The differential diagnoses of hearing loss and vestibulopathy in the context of platin-based chemotherapy, checkpoint inhibitor therapy and metastatic disease should be kept in mind for appropriate workup and therapy. Laryngoscope, 2024 We describe the case of a patient who presented with sudden onset vertigo and bilateral deafness while under immune checkpoint therapy for metastatic lung cancer. The diagnostic workup confirmed bilateral sensorineural deafness and bilateral loss of vestibular function, while imaging revealed enhancement of the vestibulocochlear nerve. Initially, immunotherapy with PD-L1 antibody atezolizumab was the assumed cause of the described symptoms. However, further findings strengthened the suspicion of meningeosis neoplastica. image