This article reports a case of severe immune checkpoint inhibitor (ICI)–related hyperglycemia accompanied by optic neuritis in a patient with extensive-stage small cell lung cancer (ES-SCLC). A 58-year-old male with right lung ES-SCLC and brain metastases underwent whole-brain radiotherapy followed by the first cycle of etoposide–cisplatin (EP) combined with serplulimab. Before the second treatment cycle, he developed ICI-related grade 3 hyperglycemia and grade 2-3 optic neuritis. Following intensive glucose control with intravenous insulin, the regimen was switched to combination of metformin, gliclazide, and short-acting insulin. Concurrently, intravenous methylprednisolone was given to manage optic neuritis. The patient responded well to treatment. The patient subsequently received EP chemotherapy for the second cycle. Beginning with the third cycle, immunotherapy was resumed, with serplulimab switched to atezolizumab. The patient successfully completed four cycles of EP plus atezolizumab, during which blood glucose levels steadily declined and returned to the normal range by the sixth treatment cycle, with no recurrence of optic neuritis. The concurrent occurrence of immune-related hyperglycemia and optic neuritis in this patient introduced complexity to clinical management. The clinical pharmacist integrated pharmaceutical knowledge with clinical practice to provide personalized recommendations for the differential diagnosis, clinical management, and therapeutic switching of immune-related adverse events, fully demonstrating the value of clinical pharmacists and providing a theoretical basis for the clinical diagnosis and treatment of complex immune-related toxicities.

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