Obata Shumpei, Saishin Yoshitsugu, Teramura Kazuya, Ohji Masahito
Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan.
Department of Dermatology, Shiga University of Medical Science, Otsu, Japan.
Case Rep Ophthalmol. 2019 Feb 8;10(1):67-74. doi: 10.1159/000496682. eCollection 2019 Jan-Apr.
Nivolumab is an anti-programmed cell death protein 1 monoclonal antibody that is used to treat metastatic cutaneous malignant melanoma. Although bilateral uveitis has been reported as a side effect of nivolumab administration, there are few reports of Vogt-Koyanagi-Harada disease (VKH)-like uveitis. We report such a case. A 63-year-old woman with metastatic cutaneous malignant melanoma experienced visual loss in both eyes 10 days after her second nivolumab injection. Her decimal best-corrected visual acuity (BCVA) was 0.7 in the right eye and 0.4 in the left eye. Examination revealed bilateral granulomatous keratic precipitates and posterior synechiae in the left eye. Optical coherence tomography showed multiple sites of serous retinal detachment (SRD) in the left eye and wavy retinal pigment epithelium in both eyes. Fluorescein angiography revealed multiple pinpoint-sized areas of leakage in both eyes and active leakage from the disc in her right eye. Indocyanine green angiography (IA) showed choroidal hyperfluorescence due to choroidal vascular leakage, with hypofluorescent dark spots during the late phase. These findings supported a diagnosis of VKH-like uveitis following nivolumab injections. Nivolumab was discontinued because of headache. Anterior chamber inflammation disappeared 3 weeks after starting topical corticosteroid treatment, and the SRD disappeared within 3 months. Her decimal BCVA recovered to 1.0 in the right eye and to 0.9 in the left eye. Also, the fluorescein angiography and IA findings had improved by 4 months. We concluded that careful follow-up is required after nivolumab treatment because VKH-like panuveitis might develop.
纳武单抗是一种抗程序性细胞死亡蛋白1单克隆抗体，用于治疗转移性皮肤恶性黑色素瘤。虽然已有报道称双侧葡萄膜炎是纳武单抗给药的副作用，但关于伏格特-小柳-原田病（VKH）样葡萄膜炎的报道却很少。我们报告了这样一例病例。一名63岁患有转移性皮肤恶性黑色素瘤的女性在第二次注射纳武单抗10天后出现双眼视力丧失。她的小数最佳矫正视力（BCVA）右眼为0.7，左眼为0.4。检查发现左眼有双侧肉芽肿性角膜后沉着物和虹膜后粘连。光学相干断层扫描显示左眼有多个浆液性视网膜脱离（SRD）部位，双眼视网膜色素上皮呈波浪状。荧光素血管造影显示双眼有多个针尖大小的渗漏区，右眼视盘有活动性渗漏。吲哚菁绿血管造影（IA）显示由于脉络膜血管渗漏导致脉络膜高荧光，晚期有低荧光暗点。这些发现支持了纳武单抗注射后发生VKH样葡萄膜炎的诊断。因头痛停用了纳武单抗。开始局部使用皮质类固醇治疗3周后前房炎症消失，SRD在3个月内消失。她的小数BCVA右眼恢复到1.0，左眼恢复到0.9。此外，荧光素血管造影和IA检查结果在4个月时有所改善。我们得出结论，纳武单抗治疗后需要密切随访，因为可能会发生VKH样全葡萄膜炎。
