Vogt-Koyanagi-Harada Syndrome induced by pembrolizumab in a patient with metastatic lung adenocarcinoma
Purpose
We report a case of VKH syndrome in a patient with metastatic lung cancer during programmed death protein-1 (PD-1) therapy
Methods
Case report
Results
A 57-year-old man with stage-IV lung adenocarcinoma and cerebral parietal lobe metastasis presented with bilateral painless loss of vision 4 months after initiating treatment with pembrolizumab. Ocular examination showed bilateral serous exudative retinal detachments of multiloculated appearance on both OCT and fluorescein angiography. Indocyanine green revealed dark hypofluorescent spots in both eyes. There was no previous ocular history of penetrating trauma or vitreoretinal surgery. VKH syndrome was diagnosed, and oral prednisolone treatment was started, as well as discontinuing pembrolizumab therapy. Complete resolution of his serous retinal detachments was observed after a month of treatment, and was therefore tapered down. There has been no evidence of recurrence 4 months after stopping steroid treatment.
Conclusion
VKH syndrome is an idiopathic, autoimmune T-cell mediated disease directed against melanocytes containing cells, where certain genetic predisposition such as, HLA haplotypes, and PD-1 gene polymorphisms have been implicated.
One of many mechanisms that maintain ocular immune privilege include RPE cell expression of PD-L1, which prevents T-cell mediated inflammation by downregulating inflammatory T-cell activity through PD-1 interaction
Monoclonal antibodies to PD-1, such as pembrolizumab prevent tumour cells from inducing immune tolerance by blocking their interaction with its ligand PD-L1. However, this has also been associated with an increased number of systemic and ocular immune-mediated side effects, including uveitis.
Conflict of interest
No
Authors 1
Last name
Menezo
Initials of first name(s)
V
Department
Uveitis Unit, Institut Català de Retina
City
Barcelona
Country
Spain
Authors 2
Last name
Aichner
Initials of first name(s)
H
Department
Institut Català de Retina
City
Barcelona
Country
Spain
Authors 3
Last name
Moya
Initials of first name(s)
I
Department
Oncology Department, Hospital Universitari General de Catalunya
City
Barcelona
Country
Spain
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