Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis.
Case Rep Ophthalmol 2021;12:952–960

中文翻译：

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纳武单抗和易普利姆玛联合治疗致Vogt-小柳-原田病样葡萄膜炎一例

Nivolumab 和 Ipilimumab 是广泛用于治疗转移性黑色素瘤的免疫检查点抑制剂 (ICPI)。由于免疫反应的激活，ICPIs 会引起一系列称为免疫相关不良事件 (IRAE) 的副作用。如果不治疗，ICPI-葡萄膜炎会导致不可逆转的视力丧失。很少有关于纳武单抗和易普利姆玛诱发的复发性 Vogt-Koyanagi-Harada (VKH) 病样葡萄膜炎的报道。我们报告了一例恢复 ICPI 后 VKH 病样葡萄膜炎复发的病例。一名患有晚期黑色素瘤的 73 岁男性在开始使用 nivolumab/ipilimumab 后 25 天因视力丧失而被转诊到我们的诊所。他的右眼矫正视力为0.5，左眼为0.02。增强深度成像光学相干断层扫描 (EDI-OCT) 显示脉络膜明显增厚。该患者因 IRAE 被诊断为 VKH 病样葡萄膜炎。进行曲安奈德潜伏注射，并暂停纳武利尤单抗/伊匹单抗，但浆液性视网膜脱离（SRD）明显恶化，出现脉络膜脱离。激素冲击治疗和口服激素2个疗程后，SRD消失，双眼矫正视力恢复。第一次注射后五个月，观察到黑色素瘤恶化，重新开始使用纳武单抗和口服类固醇。六周后，EDI-OCT 观察到脉络膜厚度增加，诊断为 VKH 病样葡萄膜炎复发。在 ICPI 给药期间监测 VKH 病样葡萄膜炎的复发，即使在葡萄膜炎得到治疗后也是如此。
Case Rep Ophthalmol 2021；12:952–960