Multiple drugs

A patient with relapsed B-cell acute lymphoblastic leukaemia developed Purtscher-like retinopathy and transplant-associated thrombotic microangiopathy following treatment with humanised CD22-targeted chimeric antigen receptor T-cell therapy, murine CD19-chimeric antigen receptor T-cell therapy, inotuzumab ozogamicin and belimumab, after undergoing allogeneic haematopoietic stem cell transplantation for leukaemia. The patient received multiple lines of immunotherapy, including CD19- and CD22-targeted CAR-T cell therapies, inotuzumab ozogamicin and belimumab, prior to allogeneic haematopoietic stem cell transplantation from an unrelated donor. Early after transplantation, the patient developed an influenza A (H1N1) infection, which was considered a likely trigger for Purtscher-like retinopathy. On post-transplant day 160, the patient experienced sudden, painless vision loss in the left eye. Ophthalmological assessment revealed retinal haemorrhages, Purtscher flecken and macular oedema, confirming the diagnosis of Purtscher-like retinopathy. By day 194, the patient developed new-onset thrombocytopenia, proteinuria and rising serum creatinine, consistent with transplant-associated thrombotic microangiopathy. The patient received management for these complications, though specific interventions and outcomes were not detailed in the report. …