A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy

Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untrea...

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Autores principales:	Keisuke Minami, Mariko Egawa, Keisuke Kajita, Fumiko Murao, Yoshinori Mitamura
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	vogt-koyanagi-harada disease-like uveitis nivolumab ipilimumab malignant melanoma panuveitis Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/bdda95afbe8143d7ab45e5aea2cdd0ce
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spelling	oai:doaj.org-article:bdda95afbe8143d7ab45e5aea2cdd0ce2021-12-02T12:40:23ZA Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy1663-269910.1159/000520416https://doaj.org/article/bdda95afbe8143d7ab45e5aea2cdd0ce2021-12-01T00:00:00Zhttps://www.karger.com/Article/FullText/520416https://doaj.org/toc/1663-2699Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis.Keisuke MinamiMariko EgawaKeisuke KajitaFumiko MuraoYoshinori MitamuraKarger Publishersarticlevogt-koyanagi-harada disease-like uveitisnivolumabipilimumabmalignant melanomapanuveitisOphthalmologyRE1-994ENCase Reports in Ophthalmology, Vol 12, Iss 3, Pp 952-960 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	vogt-koyanagi-harada disease-like uveitis nivolumab ipilimumab malignant melanoma panuveitis Ophthalmology RE1-994
spellingShingle	vogt-koyanagi-harada disease-like uveitis nivolumab ipilimumab malignant melanoma panuveitis Ophthalmology RE1-994 Keisuke Minami Mariko Egawa Keisuke Kajita Fumiko Murao Yoshinori Mitamura A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy
description	Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis.
format	article
author	Keisuke Minami Mariko Egawa Keisuke Kajita Fumiko Murao Yoshinori Mitamura
author_facet	Keisuke Minami Mariko Egawa Keisuke Kajita Fumiko Murao Yoshinori Mitamura
author_sort	Keisuke Minami
title	A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy
title_short	A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy
title_full	A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy
title_fullStr	A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy
title_full_unstemmed	A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy
title_sort	case of vogt-koyanagi-harada disease-like uveitis induced by nivolumab and ipilimumab combination therapy
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/bdda95afbe8143d7ab45e5aea2cdd0ce
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A Case of Vogt-Koyanagi-Harada Disease-Like Uveitis Induced by Nivolumab and Ipilimumab Combination Therapy

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