Acute visual loss after ipilimumab treatment for metastatic melanoma

Abstract

Background: Ipilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma. While ipilimumab provides an overall survival benefit to patients, it can be associated with immune related adverse events (IrAEs).

Case presentation: Here we describe a patient treated with ipilimumab who experienced known IrAEs, including hypophysitis, as well as a profound vision loss due to optic neuritis. There are rare reports of optic neuritis occurring as an adverse event associated with ipilimumab treatment. Furthermore, the patient experienced multiple complications from high dose steroids used to manage his IrAEs.

Conclusions: This case highlights the need for recognition of atypical immune mediated processes associated with newer checkpoint inhibitor therapies including ipilimumab.

Keywords: Checkpoint inhibitors; Immune; Ipilimumab; Melanoma; Optic neuritis; Side effects.

Fig. 1

MRI brain two months prior to onset of visual complaints, demonstrating enlargement and enhancement (arrows) of the pituitary gland consistent with hypophysitis

Fig. 2

Fundus photos, taken after onset of right eye blurred vision, demonstrating mild swelling of the right optic disc (left) and pallor of the left optic disc (right)

Fig. 3

MRI orbits after onset of right eye vision loss, demonstrating subtle circumferential perineural enhancement of bilateral optic nerves, demonstrated on axial and coronal views consistent with optic nerve inflammation (highlighted by the arrows)