Case Report: Bilateral optic nerve head masses and retinopathy in a patient with B-cell acute lymphoblastic leukemia receiving CAR T-cell therapy masquerading as fungal endophthalmitis.

Chimeric antigen receptor (CAR) T cells can traffic across tissue planes and thus have considerable potential to clear disease in sanctuary sites inaccessible to alternate systemic treatments. While of great clinical benefit, this unique capability is associated with distinctive potential toxicity. Tumor inflammation-associated neurotoxicity (TIAN) is characterized by local inflammatory toxicity at tumor sites within the CNS, presumably initiated by CAR T cells penetrating the blood-brain barrier (BBB). Specifically, ocular toxicity of CAR T-cell treatment affecting the retina and optic nerve may represent a variant of TIAN and has been infrequently described. We highlight a unique case of bilateral optic nerve head masses and retinopathy masquerading as fungal endophthalmitis in a patient with B-cell ALL treated with CAR T-cell therapy. With early recognition and a multidisciplinary approach, such cases of ocular TIAN can be effectively managed.