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Case Reports
. 2020 Jun 24;20(1):252.
doi: 10.1186/s12886-020-01519-5.

Vogt-Koyanagi-Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

Ryo Kikuchi  1 , Tatsukata Kawagoe  2   3 , Kazuki Hotta  1
Affiliations
Case Reports

Vogt-Koyanagi-Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

Ryo Kikuchi et al. BMC Ophthalmol. .

Abstract

Background: Immune checkpoint inhibitors can cause various adverse effects. Recently it has been shown that Vogt-Koyanagi-Harada (VKH) disease-like uveitis can occur in patients treated with nivolumab.

Case presentation: A 69-year-old man developed bilateral panuveitis after nivolumab treatment for recurrent hypopharyngeal cancer. Slit lamp examination revealed bilateral granulomatous keratic precipitates, anterior chamber cells and partial synechiae. Fundus examination revealed bilateral optic disc edema and diffuse serous retinal detachment. His human leukocyte antigen (HLA) typing showed HLA-DRB1*04:05 allele. A lumbar puncture did not demonstrate pleocytosis. Bilateral sub-tenon injections of triamcinolone acetonide were initiated. As his panuveitis did not regress completely, steroid pulse therapy was administered. That therapy led to the resolution of his serous retinal detachment and to rapid improvement in his vision. Following this, we treated him with 50 mg/day of prednisolone for 1 week and then reduced it by 5 mg every week. No bilateral uveitis relapse had occurred by his 3-month follow-up; however, he subsequently died because of his cancer.

Conclusion: To our knowledge, this is the first report of a patient with NVKH who underwent a lumbar puncture. Unlike VKH, our case did not show meningismus or pleocytosis. NVKH may, therefore, have a different etiology from VKH. In cases of NVKH with posterior uveitis, steroid pulse therapy may be considered as a treatment option, as it is in VKH.

Keywords: Examination of cerebrospinal fluid; HLA-DR4; Immune checkpoint inhibitors; Immune related adverse events; Nivolumab; PD-1 inhibitor; Steroid pulse therapy; Vogt–Koyanagi–Harada disease.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Color fundus photographs and optical coherence tomography (OCT) images of the right (a and c) and left (b and d) eyes at presentation. OCT image of retinal nerve fiber layer thicknesses (e) The diffuse serous retinal detachment, retinal pigment epithelium folds, and optic disc swelling are shown. Arrows indicate peaks of the retinal pigment epithelium folds
Fig. 2
Fig. 2
Fluorescein angiography and indocyanine-green angiography before systemic steroid treatment. Fluorescein angiography demonstrated multiple small leaks from the fundus in the intermediate phase (a and b). Arrowheads indicate leakages Indocyanine-green angiography also demonstrated leakage (c and d). Delayed choroidal perfusion is apparent in the early angiographic phase (31 s) (e). Hypofluorescent dark dots are visible in the intermediate phase (12 min) (f and g). Arrows point to the hypofluorescent dark dots
Fig. 3
Fig. 3
Color fundus photographs and optical coherence tomography images after steroid pulse therapy. The fundus findings had improved in both eyes. The fundus photographs show the sunset glow appearance
See this image and copyright information in PMC

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