Case report: Bilateral uveitis and  papillitis secondary to treatment with pembrolizumab

Navarro-Perea, Carmen; García-González, Javier; Pérez-Blázquez, Eugenio

doi:10.4103/ijo.ijo_1161_19

Cited by 14 publications

(6 citation statements)

References 6 publications

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“…HLA-DRB1*04:05 may be one of the causes of both NVKH and VKH. Unlike VKH, our Recently, it has been learned that other immune checkpoint inhibitors such as anti-PD-1 antibody pembrolizumab and anti-PD-L1 antibody atezolizumab are also capable of causing VKH-like uveitis [14,15]. It is expected that further reports about these drugs will elucidate the mechanism of immune checkpoint inhibitorinduced diseases.…”

Section: Discussionmentioning

confidence: 99%

Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

2020

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Background: Immune checkpoint inhibitors can cause various adverse effects. Recently it has been shown that Vogt-Koyanagi-Harada (VKH) disease-like uveitis can occur in patients treated with nivolumab. Case presentation: A 69-year-old man developed bilateral panuveitis after nivolumab treatment for recurrent hypopharyngeal cancer. Slit lamp examination revealed bilateral granulomatous keratic precipitates, anterior chamber cells and partial synechiae. Fundus examination revealed bilateral optic disc edema and diffuse serous retinal detachment. His human leukocyte antigen (HLA) typing showed HLA-DRB1*04:05 allele. A lumbar puncture did not demonstrate pleocytosis. Bilateral sub-tenon injections of triamcinolone acetonide were initiated. As his panuveitis did not regress completely, steroid pulse therapy was administered. That therapy led to the resolution of his serous retinal detachment and to rapid improvement in his vision. Following this, we treated him with 50 mg/ day of prednisolone for 1 week and then reduced it by 5 mg every week. No bilateral uveitis relapse had occurred by his 3-month follow-up; however, he subsequently died because of his cancer. Conclusion: To our knowledge, this is the first report of a patient with NVKH who underwent a lumbar puncture. Unlike VKH, our case did not show meningismus or pleocytosis. NVKH may, therefore, have a different etiology from VKH. In cases of NVKH with posterior uveitis, steroid pulse therapy may be considered as a treatment option, as it is in VKH.

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Section: Discussionmentioning

confidence: 99%

Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

2020

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“…Numerous cases of uveitis have been described as consequent on the immune checkpoint inhibitors 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , with only a few occurring secondary to durvalumab treatment. 6 , 7 , 8 This is likely due to both: fewer patients treated with durvalumab in proportion to the other immune checkpoint inhibitors 6 , 16 and more frequent and severe side effects of cytotoxic T lymphocyte-associated protein 4 (CTLA-4) inhibitors compared to the PD-1 and PD-L1 inhibitors.…”

Section: Resultsmentioning

confidence: 99%

“…Uveitic complications secondary to ICIs are commonly treated with a local and/or systemic corticosteroid. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 There is little experience in treating uveitic complications of ICI with other immunomodulatory therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Some uveitic cases resolve with discontinuation of ICI therapy 7 , 13 ; in others, the inflammation may persist after ICI discontinuation. 18 In our first case, the patient was discontinued from durvalumab treatment not only due to grade 3 ocular toxicity according to Common terminology criteria for adverse events (CTCAE) and disease progression but also due to the progression of the underlying ESSCLC.…”

Section: Discussionmentioning

confidence: 99%

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Various clinical presentations of uveitis associated with durvalumab treatment

Vrabič

Fakin

Mekjavič

et al. 2022

Radiology and Oncology

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Background Immune checkpoint inhibitors (ICI) are becoming increasingly common in treating several cancer types. Durvalumab is a human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80 and has recently been approved for the treatment of extensive-stage small-cell lung cancer (ES-SCLC) and locally advanced unresectable (NSCLC). The present review aimed to analyse immune-mediated uveitis, secondary to durvalumab treatment, through a review of the literature and a presentation of two clinical cases. Patients and methods A literature review using PubMed search was conducted to identify cases of uveitis secondary to durvalumab and cases of uveitis with optic disc oedema secondary to ICI use that were reported prior to November 14, 2021. Additionally, we report two cases of uveitis consequent on durvalumab treatment. Results Five cases of uveitis secondary to durvalumab use were identified in the literature. Anterior, posterior uveitis and vasculitis were reported. Additionally, we present a case of bilateral intermediate uveitis with bilateral optic disc oedema and a case of bilateral posterior uveitis. Our further search revealed 12 cases of uveitis with optic disc oedema secondary to ICI use, with the majority of cases reported secondary to PD-1 inhibitors. Conclusions Rarely reported, uveitis secondary to durvalumab can present various clinical pictures and requires a thorough diagnostic workup. Once the diagnosis is established, treatment, commonly with a local or systemic corticosteroid, should be adapted to the severity of the inflammation.

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“…These include hepatitis, colitis, pneumonitis, hypothyroidism, and cutaneous adverse events [ 7 ]. These adverse events are believed to be due to the lack of inhibition of T-cells [ 8 ]. The cutaneous adverse effects can affect the quality of life of the patients and can result in dose reduction or even discontinuation of the treatment [ 2 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab-Induced Acute Skin Reaction: A Case Report and Review of Literature

Thomas¹,

Wazir²,

Poudel³

2022

Cureus

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The development of immune checkpoint inhibitors is considered to be one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-ligand 1 (PD-L1) receptor that has demonstrated antineoplastic activity against various malignancies including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab has been associated with significant dermatological adverse reactions, referred to as immune-related adverse events. The cutaneous adverse effects can affect the quality of life of the patient and can result in dose reduction or even discontinuation of the treatment. Hence it is of utmost importance to have a comprehensive understanding of the cutaneous toxicities for prompt initiation of treatment. We present the case of a 49-year-old male with metastatic non-small cell lung cancer (NSCLC) with 100% PD-L1 expression, who suffered a severe cutaneous reaction involving more than 95% of body surface area, following the first dose of pembrolizumab. He was treated with low-dose systemic steroids (prednisone 10 mg), to which he responded well. Since the patient showed excellent symptomatic and clinical response to pembrolizumab, it was not discontinued. The patient has not developed a rash with subsequent doses of pembrolizumab, and the steroids were tapered off.

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Case report: Bilateral uveitis and papillitis secondary to treatment with pembrolizumab

Cited by 14 publications

References 6 publications

Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

Various clinical presentations of uveitis associated with durvalumab treatment

Pembrolizumab-Induced Acute Skin Reaction: A Case Report and Review of Literature

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