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Case with metastatic cutaneous malignant melanoma that developed Vogt–Koyanagi–Harada-like uveitis following pembrolizumab treatment

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Abstract

Purpose

The study reports a case with metastatic cutaneous malignant melanoma that developed Vogt–Koyanagi–Harada-like uveitis during pembrolizumab treatment. The uveitis improved by discontinuation of pembrolizumab and use of oral and topical steroids. Full-field flicker ERGs were used to monitor the retinal function before and after the steroid treatments.

Case report

A 68-year-old women presented with blurred vision in both eyes 3 months after beginning pembrolizumab adjuvant therapy for a malignant melanoma on the lower thigh. Optical coherence tomography showed a serous retinal detachment (SRD) in the right eye and marked choroidal thickening in both eyes. Fluorescein angiography showed spotted hyperfluorescence in the right eye and leakage of fluorescein from both optic disks. Indocyanine green angiography showed dark hypofluorescent spots in both eyes. She was diagnosed with Vogt–Koyanagi–Harada-like uveitis induced by pembrolizumab and discontinued the pembrolizumab. She was then treated with oral prednisolone and topical betamethasone. One week later, the symptoms were improved, and 1 month later the choroidal thickening in both eyes and the SRD of the right eye were not present. The implicit time of the full-field flicker ERGs recorded by RETeval system was significantly delayed at the initial examination but improved within a few weeks after the steroid replacement treatment.

Conclusion

Our case with Vogt–Koyanagi–Harada-like uveitis induced by pembrolizumab had a reduction in the degree of uveitis after discontinuation of the pembrolizumab and use of oral prednisolone and topical betamethasone. Flicker ERGs were helpful in monitoring the retinal function before and after the steroid treatment.

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Acknowledgements

We thank Professor Emeritus Duco I. Hamasaki of the Bascom Palmer Eye Institute of the University of Miami (Miami, FL, USA) for critical discussion and final manuscript revisions.

Funding

H. Enomoto, none; K. Kato, None; A. Sugawara, None; M. Itabashi, None; M. Kondo, Novartis (F). Grant-in-Aid for Scientific Research C (MK, 18H02954 and 17K19721) from Ministry of Education, Culture, Sports, Science and Technology.

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Authors and Affiliations

  1. Department of Ophthalmology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Hiroko Enomoto, Kumiko Kato, Asako Sugawara, Moe Itabashi & Mineo Kondo

Authors
  1. Hiroko Enomoto
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  2. Kumiko Kato
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  3. Asako Sugawara
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  4. Moe Itabashi
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  5. Mineo Kondo
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Contributions

KK, HE and MK wrote the main manuscript. AS and MI collected the data. All authors reviewed the manuscript.

Corresponding author

Correspondence to Kumiko Kato.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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No animals were used in this study.

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Enomoto, H., Kato, K., Sugawara, A. et al. Case with metastatic cutaneous malignant melanoma that developed Vogt–Koyanagi–Harada-like uveitis following pembrolizumab treatment. Doc Ophthalmol 142, 353–360 (2021). https://doi.org/10.1007/s10633-020-09800-0

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  • DOI: https://doi.org/10.1007/s10633-020-09800-0

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