Vogt-Koyanagi-Harada-like uveitis under immune checkpoint inhibitor treatment for metastasized malignant melanoma

Abstract

This article presents the case of a 68-year-old female patient who reported bilateral progressive visual loss over 4 weeks. The patient had a known metastatic malignant cutaneous melanoma, which was treated with the immune checkpoint inhibitors nivolumab and ipilimumab. The ophthalmological examination revealed a bilateral anterior chamber flare with endothelial precipitates as well as choroidal folds, an orange-red discoloration of the retina and a serous retinal/choroidal detachment in the left eye. In the course of time the patient developed poliosis and vitiligo. Systemic and local steroid treatment resulted in a distinct improvement of the findings. An intravitreal triamcinolone injection led to complete regression of the progressive macular edema. In rare cases immune checkpoint inhibitors can cause Vogt-Koyanagi-Harada-like uveitis. As ocular inflammation can be well controlled by local and systemic steroids, checkpoint inhibitor treatment should be continued in cases with good treatment response whenever possible. Interdisciplinary cooperation with close controls is absolutely necessary in these cases.