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

Abstract

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.

Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm

“…A very recent larger review of 126 cases of CPI-associated uveitis was broadly consistent, noting that 35% of panuveitis cases occurred as part of a Vogt–Koyanagi–Harada (VKH)-like syndrome. 27 – 30 VKH disease is a multisystem disease affecting melanin-containing tissues, which is thought to be autoimmune in origin. The most significant ocular manifestation is bilateral diffuse panuveitis with exudative retinal detachment, often accompanied by a variable spectrum of symptoms involving the skin, nervous system and inner ear.…”

Various clinical presentations of uveitis associated with durvalumab treatment

“…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.…”

“…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.…”

Nivolumab-induced Vogt-Koyanagi-Harada-like Syndrome and Adrenocortical Insufficiency with Long-term Survival in a Patient with Non-small-cell Lung Cancer

“…In a previous report, one patient with VKH disease-like uveitis as an irAE without symptoms of other organs was treated with only topical steroid. However, the standard treatment for VKH disease is high-dose systemic corticosteroids, which was administered to six other patients ( Table ) ( 18 - 23 ). In the present case, the irAE uveitis appeared initially and was successfully treated with a topical steroid; however, the patient sequentially developed hearing loss and adrenal insufficiency, thus requiring systemic corticosteroid therapy.…”