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免疫检查点抑制剂治疗转移性恶性黑色素瘤时出现的类伏格特-小柳-原田葡萄膜炎

[Vogt-Koyanagi-Harada-like uveitis under immune checkpoint inhibitor treatment for metastasized malignant melanoma].

作者信息

Mihailovic Nataša, Dyballa Jörg, Herz Saskia, Fluck Michael, Alnawaiseh Maged, Merté Ralph-Laurent, Eter Nicole

机构信息

Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland.

Fachklinik Hornheide, Internistische und Hämatologische Onkologie, Münster, Deutschland.

出版信息

Ophthalmologe. 2020 May;117(5):467-471. doi: 10.1007/s00347-019-00963-z.

Abstract

This article presents the case of a 68-year-old female patient who reported bilateral progressive visual loss over 4 weeks. The patient had a known metastatic malignant cutaneous melanoma, which was treated with the immune checkpoint inhibitors nivolumab and ipilimumab. The ophthalmological examination revealed a bilateral anterior chamber flare with endothelial precipitates as well as choroidal folds, an orange-red discoloration of the retina and a serous retinal/choroidal detachment in the left eye. In the course of time the patient developed poliosis and vitiligo. Systemic and local steroid treatment resulted in a distinct improvement of the findings. An intravitreal triamcinolone injection led to complete regression of the progressive macular edema. In rare cases immune checkpoint inhibitors can cause Vogt-Koyanagi-Harada-like uveitis. As ocular inflammation can be well controlled by local and systemic steroids, checkpoint inhibitor treatment should be continued in cases with good treatment response whenever possible. Interdisciplinary cooperation with close controls is absolutely necessary in these cases.

摘要

本文介绍了一名68岁女性患者的病例,该患者报告在4周内出现双侧进行性视力丧失。患者患有已知的转移性恶性皮肤黑色素瘤,接受了免疫检查点抑制剂纳武单抗和伊匹单抗治疗。眼科检查发现双侧前房有炎症细胞及内皮沉着物、脉络膜皱褶、视网膜橙红色变色以及左眼浆液性视网膜/脉络膜脱离。随着时间推移,患者出现白发症和白癜风。全身及局部类固醇治疗使症状明显改善。玻璃体内注射曲安奈德导致进行性黄斑水肿完全消退。在罕见情况下,免疫检查点抑制剂可引起伏格特-小柳-原田样葡萄膜炎。由于眼部炎症可通过局部和全身类固醇得到良好控制,只要治疗反应良好,在可能的情况下应继续进行检查点抑制剂治疗。在这些病例中,跨学科合作及密切监测绝对必要。

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