Other / General Medicine
Pranav Bollavaram, MD
Cancer Rehabilitation Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Sammy Wu, MD
Cancer Rehabilitation Physiatrist
Memorial Sloan Kettering Cancer Center
White Plains, New York, United States
Grigory Syrkin, MD
Cancer Rehabilitation Physiatrist
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Pranav Bollavaram, MD
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Acute unilateral brachial neuritis attributed to CAR-T therapy.
Case Description: This case describes a 24-year-old male with a history of acute myeloid leukemia who underwent allogenic stem cell transplant twice followed by chimeric antigen receptor T-cell (CAR-T) therapy, specifically with the agent ADCLEC.syn1. At the time of this last infusion, he did not have specific neurological or musculoskeletal deficits. Roughly 20 days after CAR-T, he was admitted to the hospital with neutropenic fever and left-sided neck pain. His fever was attributed to S. epidermidis bacteremia and treated with antibiotics. Regarding neck symptoms, examination revealed pain-limited range of motion with neck rotation and left shoulder abduction, with associated weakness. He had allodynia over the left supraclavicular and lateral neck region. MRI of the left brachial plexus showed an infiltrating soft-tissue mass in the left supraclavicular fossa involving the proximal brachial plexus, suggestive of a progressive inflammatory process. A biopsy of this mass revealed fragments of fibrous tissue with post-therapy effects.
Discussions:
The patient's pain improved with temporary oral steroids and was subsequently managed by narcotic and neuropathic pain meds. He received physical and occupational therapy, which improved his shoulder pain and range of motion. This case highlights a rare adverse effect of CAR-T therapy, in the form of unilateral brachial neuritis. The patient’s presentation is consistent with brachial neuritis, including pain and weakness in the proximal left arm. It is reasonable to associate his symptoms with CAR-T therapy given the temporal relationship and the biopsy findings of post-treatment affected cells. While CAR-T is associated with cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and other neurologic impairments, a literature review suggests this is the first case of post-treatment brachial neuritis.
Conclusions: As investigations evolve regarding CAR-T, cataloguing side effects, especially those of a neuromusculoskeletal nature, are important in maintaining the function of cancer rehabilitation patients.
