Multifocal choroiditis as the first sign of systemic sarcoidosis associated with pembrolizumab

PURPOSE: To report a case of bilateral panuveitis with multifocal choroiditis associated with a systemic sarcoidosis unmasked by pembrolizumab. CASE REPORT: A 68-years old woman with a history of metastatic melanoma treated by pembrolizumab consulted for bilateral blurred vision. The ophthalmologic examination revealed a bilateral anterior uveitis with cells in the anterior chamber and granulomatous keratic precipitates, vitreous cells and multifocal choroiditis confirmed by indocyanine green angiography. The systemic workup revealed pulmonary sarcoidosis confirmed by biopsy. CONCLUSIONS AND IMPORTANCE: Pembrolizumab is an immune checkpoint inhibitor therapy used in the treatment of metastatic melanoma. We report a pembrolizumab-associated sarcoidosis revealed by a panuveitis with multifocal choroiditis. Physicians should be aware of the potential inflammatory and autoimmune disease that may be induced by immunomodulatory therapies.