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A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer

PURPOSE: To report a case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer. OBSERVATIONS: A 71-year-old man, who was diagnosed with metastatic lung cancer (squamous cell carcinoma), presented with blurry vision 2 weeks after the initiation of pemb...

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Autores principales: Kim, Kyung Woo, Kusuhara, Sentaro, Tachihara, Motoko, Mimura, Chihiro, Matsumiya, Wataru, Nakamura, Makoto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995477/
https://www.ncbi.nlm.nih.gov/pubmed/33796799
http://dx.doi.org/10.1016/j.ajoc.2021.101072
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author Kim, Kyung Woo
Kusuhara, Sentaro
Tachihara, Motoko
Mimura, Chihiro
Matsumiya, Wataru
Nakamura, Makoto
author_facet Kim, Kyung Woo
Kusuhara, Sentaro
Tachihara, Motoko
Mimura, Chihiro
Matsumiya, Wataru
Nakamura, Makoto
author_sort Kim, Kyung Woo
collection PubMed
description PURPOSE: To report a case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer. OBSERVATIONS: A 71-year-old man, who was diagnosed with metastatic lung cancer (squamous cell carcinoma), presented with blurry vision 2 weeks after the initiation of pembrolizumab monotherapy. His best-corrected visual acuity (BCVA) was 20/20 OU, and slitlamp examination revealed fine keratic precipitates, anterior chamber cells (1+) and flare (1+) in both eyes. Dilated fundus examination showed no remarkable finding in the right eye and vitreous haze (2+), perivascular exudates, and vessel sheathing in the left eye. Fluorescence angiography demonstrated dye leakage from the optic disc and both retinal arteries and veins extending from the posterior to the peripheral retina in both eyes. The patient was diagnosed with panuveitis and retinal vasculitis as Grade 3 immune-related adverse event (irAE). Pembrolizumab was discontinued and oral prednisone 70mg/day was given for 1 week. The dose was reduced to 30mg/day for the next 3 weeks and was then stopped. One month after the treatment, intraocular inflammation became quiescent. With a good response to the treatment of irAE, pembrolizumab was restarted. Recurrence of ocular inflammation occurred over the next 1.5 years, but all of which were successfully treated with sub-Tenon's injection of triamcinolone acetonide (STTA). The patient maintained BCVA of 30/20 OU at the latest visit. CONCLUSIONS AND IMPORTANCE: We showed a case of retinal vasculitis occurred as an irAE of pembrolizumab for metastatic lung cancer. Retinal vasculitis was well managed with transient pembrolizumab discontinuation and oral corticosteroid therapy, and pembrolizumab was restarted with the aid of STTA. As ocular irAEs might be controlled by local corticosteroid therapy, the decision to continue immune checkpoint inhibitor therapy should be made on a case-by-case basis.
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spelling pubmed-79954772021-03-31 A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer Kim, Kyung Woo Kusuhara, Sentaro Tachihara, Motoko Mimura, Chihiro Matsumiya, Wataru Nakamura, Makoto Am J Ophthalmol Case Rep Case Report PURPOSE: To report a case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer. OBSERVATIONS: A 71-year-old man, who was diagnosed with metastatic lung cancer (squamous cell carcinoma), presented with blurry vision 2 weeks after the initiation of pembrolizumab monotherapy. His best-corrected visual acuity (BCVA) was 20/20 OU, and slitlamp examination revealed fine keratic precipitates, anterior chamber cells (1+) and flare (1+) in both eyes. Dilated fundus examination showed no remarkable finding in the right eye and vitreous haze (2+), perivascular exudates, and vessel sheathing in the left eye. Fluorescence angiography demonstrated dye leakage from the optic disc and both retinal arteries and veins extending from the posterior to the peripheral retina in both eyes. The patient was diagnosed with panuveitis and retinal vasculitis as Grade 3 immune-related adverse event (irAE). Pembrolizumab was discontinued and oral prednisone 70mg/day was given for 1 week. The dose was reduced to 30mg/day for the next 3 weeks and was then stopped. One month after the treatment, intraocular inflammation became quiescent. With a good response to the treatment of irAE, pembrolizumab was restarted. Recurrence of ocular inflammation occurred over the next 1.5 years, but all of which were successfully treated with sub-Tenon's injection of triamcinolone acetonide (STTA). The patient maintained BCVA of 30/20 OU at the latest visit. CONCLUSIONS AND IMPORTANCE: We showed a case of retinal vasculitis occurred as an irAE of pembrolizumab for metastatic lung cancer. Retinal vasculitis was well managed with transient pembrolizumab discontinuation and oral corticosteroid therapy, and pembrolizumab was restarted with the aid of STTA. As ocular irAEs might be controlled by local corticosteroid therapy, the decision to continue immune checkpoint inhibitor therapy should be made on a case-by-case basis. Elsevier 2021-03-12 /pmc/articles/PMC7995477/ /pubmed/33796799 http://dx.doi.org/10.1016/j.ajoc.2021.101072 Text en © 2021 The Authors. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Kim, Kyung Woo
Kusuhara, Sentaro
Tachihara, Motoko
Mimura, Chihiro
Matsumiya, Wataru
Nakamura, Makoto
A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
title A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
title_full A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
title_fullStr A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
title_full_unstemmed A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
title_short A case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
title_sort case of panuveitis and retinal vasculitis associated with pembrolizumab therapy for metastatic lung cancer
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995477/
https://www.ncbi.nlm.nih.gov/pubmed/33796799
http://dx.doi.org/10.1016/j.ajoc.2021.101072
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