Tan Charissa H, Sayegh Yoseph, Fasih-Ahmad Sohaib, Tse David T, Karp Carol L, Dubovy Sander R
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Johns Hopkins Hospital, Baltimore, MD, USA.
Am J Ophthalmol Case Rep. 2024 Feb 18;36:102025. doi: 10.1016/j.ajoc.2024.102025. eCollection 2024 Dec.
Conjunctival melanoma is a rare neoplasm with high rates of recurrence and metastasis. Traditional management includes surgical excision and cryotherapy, followed by adjuvant therapy as needed. Immune checkpoint inhibitors, including nivolumab, are a targeted treatment option with improved survival rates. However, various immune-related adverse effects have been reported with these drugs. While systemic granulomatous inflammation is a documented systemic side effect, it has rarely been reported in the conjunctiva and ocular adnexa.
A patient with a history of recurrent metastatic conjunctival melanoma presented with both a left sub-conjunctival and upper eyelid lesion after the commencement of treatment with nivolumab. The lesions were excised with a clinical suspicion for metastasis and consisted of noncaseating granulomatous inflammation with no evidence of malignancy on histopathologic examination. Infectious and primary autoimmune etiologies were ruled out.
This is a biopsy-proven case of periocular immune checkpoint inhibitor-associated granulomatous inflammation.
结膜黑色素瘤是一种罕见的肿瘤，复发和转移率高。传统治疗方法包括手术切除和冷冻疗法，必要时进行辅助治疗。免疫检查点抑制剂，包括纳武单抗，是一种可提高生存率的靶向治疗选择。然而，使用这些药物已报告了各种免疫相关不良反应。虽然全身性肉芽肿性炎症是一种已记录的全身性副作用，但在结膜和眼附属器中很少有报道。
一名复发性转移性结膜黑色素瘤患者在开始使用纳武单抗治疗后出现左结膜下和上睑病变。临床怀疑转移而切除病变，组织病理学检查显示为非干酪样肉芽肿性炎症，无恶性证据。排除了感染性和原发性自身免疫性病因。
这是一例经活检证实的眼周免疫检查点抑制剂相关肉芽肿性炎症病例。
