Recurrent audiovestibular dysfunction and associated neurological immune-related adverse events in a melanoma patient treated with nivolumab and ipilimumab

Background: Recurrent immunotherapy-induced audiovestibular toxicity despite cessation of therapy has not been reported. Methods: We report the first case of recurrent audiovestibular toxicity following immune-checkpoint inhibitor (ICI) therapy. The patient was seen with sudden bilateral hearing loss and disequilibrium. After ruling out other etiologies, he was diagnosed with audiovestibular and neurological immune-related adverse events (irAEs). He received systemic steroids, with significant hearing and balance recovery. Over the following 4 months, he experienced two other episodes of sudden bilateral hearing loss despite ICIs cessation. The second episode was treated with oral steroids, and hearing improved. On the third episode, he received oral and intratympanic steroids, and he was started on infliximab. Results: Audiogram 8 months following the last recurrence showed hearing improvement and stability. Conclusion: Immunotherapy-induced ototoxicity may recur despite therapy cessation. High dose steroids remain the mainstay of treatment. If audiovestibular irAEs recur despite multiple courses of steroids, immunosuppressive agents may be considered.