Nivolumab induced Vogt-Koyanagi-Harada Syndrome managed with fluocinolone acetonide intravitreal implants: a case report
Purpose
To describe a case of a rare ocular adverse effect of Nivolumab managed with bilateral intravitreal fluocinolone acetonide (FA) implants.
Methods
Retrospective case report.
Results
A 57-year-old woman with metastatic renal clear cell carcinoma to the lungs, undergoing Nivolumab, presented to the Ophthalmology emergency with bilateral (OU) subacute visual acuity (VA) loss (20/200 OU). Examination revealed panuveitis with marked choroid thickening, consistent with a Vogt-Koyanagi-Harada (VKH)-like syndrome. The patient was treated with topical and systemic corticosteroids. After 2 months, VA improved to 20/25 OU and intraocular inflammation resolved. Due to clinical remission, the Oncology team decided to discontinue Nivolumab. During follow-up, the patient developed relapsing cystoid macular edema (CME), which was managed with FA implants OU. On her last visit, VA was stable (20/25 OU) with complete resolution of the CME.
Conclusion
Immune checkpoint inhibitors (ICIs) are associated with a variety of immune-related side effects (irAEs) which result from overactive immune responses, promoted by their mechanism of action. ICIs can be suspended or delayed, but corticosteroids often successfully control side effects. This report highlights the importance of an individual approach to irAEs and the need to adequate guidelines to the patients’ needs.
Conflict of interest
No
Authors 1
Last name
MACHADO
Initials of first name(s)
T
Department
Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC)
City
Coimbra
Country
Portugal
Authors 2
Last name
Simões
Initials of first name(s)
J
Department
Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC)
City
Coimbra
Country
Portugal
Authors 3
Last name
Fonseca
Initials of first name(s)
C
Department
Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC)
City
Coimbra
Country
Portugal
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