Purpose

The study reports a case with metastatic cutaneous malignant melanoma that developed Vogt–Koyanagi–Harada-like uveitis during pembrolizumab treatment. The uveitis improved by discontinuation of pembrolizumab and use of oral and topical steroids. Full-field flicker ERGs were used to monitor the retinal function before and after the steroid treatments.

Case report

A 68-year-old women presented with blurred vision in both eyes 3 months after beginning pembrolizumab adjuvant therapy for a malignant melanoma on the lower thigh. Optical coherence tomography showed a serous retinal detachment (SRD) in the right eye and marked choroidal thickening in both eyes. Fluorescein angiography showed spotted hyperfluorescence in the right eye and leakage of fluorescein from both optic disks. Indocyanine green angiography showed dark hypofluorescent spots in both eyes. She was diagnosed with Vogt–Koyanagi–Harada-like uveitis induced by pembrolizumab and discontinued the pembrolizumab. She was then treated with oral prednisolone and topical betamethasone. One week later, the symptoms were improved, and 1 month later the choroidal thickening in both eyes and the SRD of the right eye were not present. The implicit time of the full-field flicker ERGs recorded by RETeval system was significantly delayed at the initial examination but improved within a few weeks after the steroid replacement treatment.

Conclusion

Our case with Vogt–Koyanagi–Harada-like uveitis induced by pembrolizumab had a reduction in the degree of uveitis after discontinuation of the pembrolizumab and use of oral prednisolone and topical betamethasone. Flicker ERGs were helpful in monitoring the retinal function before and after the steroid treatment.

中文翻译：

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帕博利珠单抗治疗后发生 Vogt-Koyanagi-Harada 样葡萄膜炎的转移性皮肤恶性黑色素瘤病例

目的

该研究报告了一例转移性皮肤恶性黑色素瘤病例，该病例在派姆单抗治疗期间出现 Vogt-Koyanagi-Harada 样葡萄膜炎。通过停用派姆单抗和使用口服和外用类固醇，葡萄膜炎得到改善。使用全场闪烁 ERG 监测类固醇治疗前后的视网膜功能。

案例报告

一名 68 岁女性在开始帕博利珠单抗辅助治疗大腿下部恶性黑色素瘤后 3 个月出现双眼视力模糊。光学相干断层扫描显示右眼有浆液性视网膜脱离 (SRD)，双眼脉络膜显着增厚。荧光素血管造影显示右眼有斑点高荧光，两个视盘都有荧光素渗漏。吲哚菁绿血管造影显示双眼有深色低荧光斑点。她被诊断出患有由派姆单抗引起的 Vogt-Koyanagi-Harada 样葡萄膜炎，并停用了派姆单抗。然后她接受了口服泼尼松龙和局部倍他米松的治疗。1周后症状好转，1个月后双眼脉络膜增厚和右眼SRD均未出现。评估系统在初始检查时明显延迟，但在类固醇替代治疗后的几周内有所改善。

结论

我们的病例是由派姆单抗引起的 Vogt-Koyanagi-Harada 样葡萄膜炎，在停用派姆单抗并使用口服泼尼松龙和局部倍他米松后，葡萄膜炎的程度有所减轻。闪烁 ERG 有助于监测类固醇治疗前后的视网膜功能。