Aaberg Michael T, Aaberg Thomas M
*Dartmouth College, Hanover, New Hampshire; and †Michigan State University, Grand Rapids, Michigan.
Retin Cases Brief Rep. 2017;11(4):348-351. doi: 10.1097/ICB.0000000000000368.
To describe the development of uveitis and retinal vasculitis in association with pembrolizumab treatment for metastatic uveal melanoma.
A case report and a brief review of the literature are presented. Information collected and reported include the patient's clinical course, physical examination findings, fluorescein angiogram images, retinal photographs, and her response to treatment.
A 54-year-old woman was diagnosed with a large choroidal malignant melanoma and had the affected eye enucleated. Pathology confirmed a mixed cell choroidal melanoma, and gene expression profiling was Class 2. Seventeen months after enucleation, the patient was diagnosed with metastatic uveal melanoma to the liver. Disease progression was observed during ipilimumab treatment. Pembrolizumab treatment was initiated, and after four infusions, she presented to clinic complaining of floaters and blurred vision. Examination revealed a nongranulomatous panuveitis characterized by perivascular retinal pigment epithelium pigmentary changes, retinal venous sheathing, 1+ anterior chamber and vitreous cellular reaction, 2+ vitreous haze, and optic disk edema. A dexamethasone sustained-release implant was administered and the uveitis regressed. A relapse in symptoms occurred but quickly subsided with a repeat injection.
Pembrolizumab may induce a uveitic reaction. There is mounting evidence that patients using prembrolizumab should be educated and monitored for signs of uveitis.
描述与派姆单抗治疗转移性葡萄膜黑色素瘤相关的葡萄膜炎和视网膜血管炎的发生情况。
呈现一例病例报告并对文献进行简要综述。收集并报告的信息包括患者的临床病程、体格检查结果、荧光素血管造影图像、视网膜照片以及她对治疗的反应。
一名54岁女性被诊断患有巨大脉络膜恶性黑色素瘤，患眼被摘除。病理证实为混合细胞脉络膜黑色素瘤，基因表达谱为2类。眼球摘除术后17个月，患者被诊断为肝转移性葡萄膜黑色素瘤。在使用伊匹单抗治疗期间观察到疾病进展。开始使用派姆单抗治疗，四次输注后，她到诊所就诊，主诉有飞蚊症和视力模糊。检查发现非肉芽肿性全葡萄膜炎，其特征为视网膜色素上皮血管周围色素改变、视网膜静脉鞘膜形成、前房和玻璃体1+细胞反应、2+玻璃体混浊以及视盘水肿。给予地塞米松缓释植入剂后葡萄膜炎消退。症状复发，但再次注射后迅速缓解。
派姆单抗可能诱发葡萄膜炎反应。越来越多的证据表明，使用派姆单抗的患者应接受教育并监测葡萄膜炎的体征。
