Vogt–Koyanagi–Harada disease during chemoimmunotherapy for non‐small cell lung cancer

Abstract

Vogt–Koyanagi–Harada disease (VKHD) is a rare systemic granulomatous autoimmune disease that affects melanocyte‐rich organs such as eye, inner ear, meninges, skin, and hair. VKHD leads to chronic uveal inflammation accompanied by a decline in visual acuity in some patients when appropriate corticosteroid treatment was not initiated in an early phase. Immune checkpoint inhibitors (ICIs) are widely used in the treatment of several kinds of cancers and chemoimmunotherapy has become the standard of care in the first‐line treatment of non‐small cell lung cancer (NSCLC). While ICIs induce immune‐related adverse events, drug‐induced VKHD is quite rare with only four reports in the ICI monotherapy; three patients with melanoma and one patient with NSCLC. We describe the first case of VKHD during chemoimmunotherapy including pembrolizumab in a patient with NSCLC, which was successfully treated with corticosteroid without any sequela.

Vogt-Koyanagi-Harada disease diagnosed in members of the same family

“…Therefore, to avoid delay in treatment and the development of vision-threatening complications, which tend to occur primarily in patients with long-standing ocular inflammation, it is important to recognize the variable clinical presentations of the disease. The use of diagnostic imaging methods, such as optical coherence tomography, is essential to monitor disease activity, in order to promote early treatment and prevent the development of ocular complications [2,9,17,[20][21][22].…”

“…The use of immunomodulatory agents such as Azathioprine, Mycophenolate Mofetil and Cyclosporine reduced the risk of developing eye complications. However, a considerable number of patients still progress to chronic stages, suffer relapses and progress to visual loss, probably due to undetectable and undertreated subclinical inflammation [ 8,11,18,[21][22][23][24].…”

“…Topical corticosteroids and cycloplegic agents are effective in controlling anterior segment inflammation. Addition of immunosuppressive agents such as mycophenolate mofetil, methotrexate, cyclosporine, or azathioprine are generally considered in patients who are not controlled with corticosteroids alone or cannot be tapered to a safe low dose for the long period of time they need to control their inflammation [13,17,[20][21][22][23][24].…”

Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer

“…All clinical features of the above-mentioned three types of uveitis were revealed in panuveitis ( Table 3 ). Moreover, Vogt-Koyanagi-Harada disease is a common ocular irAE associated with ICIs ( 45 , 58 , 105 ). It is a type of bilateral granulomatous uveitis, associated with exudative retinal detachment and extraocular manifestations, such as pleocytosis in the cerebrospinal fluid and, in some cases, vitiligo, poliosis, alopecia, and dysacusis.…”

Vogt – Koyanagi Harada Syndrome in a Pakistani Female

“…2 This syndrome consists of four clinical stages: a) in first stage there are nonspecific symptoms such as nausea, fever and the neurological symptoms like headaches, muscle weakness; 2) ophthalmologic stage, in which patients complain of blurred vision, pain, photophobia or central scotoma (bilateral in 80% of the cases); bilateral serous retinal detachment often occurs, tinnitus is often present; 3) third stage, occurs within months from the onset and is characterized by poliosis involving the eyebrows, eyelashes, hair loss and vitiligo; 4) chronic recurrent stage: recurrent uveitis and ophthalmological complications. 3 The aim to report this case is to familiarize ophthalmologists and health care professionals about its findings and complications that are usually found in such patients.…”