Unilateral Posterior Uveitis in a Patient Receiving Nivolumab for Malignant Melanoma

Abstract

Patients using immunotherapies like immune checkpoint inhibitors (ICIs) can develop ocular immune-related adverse effects (irAEs). Nivolumab (Opdivo^®;Bristol-Myers Squibb, New York, NY, USA) is a commonly used ICI used to treat malignancies. A 75-year-old woman presented to our eye clinic with sudden loss in vision in the right eye. She had started nivolumab monotherapy 10 days before the onset of symptoms for the treatment of melanoma. Examination showed low visual acuity (20/170) in the right eye with few reactive cells and macular oedema and swelling in the anterior and posterior segments, respectively. Optical coherence tomography (OCT) of the right eye showed intra-retinal and sub-retinal fluid and multiple hyperreflective inner retinal round foci in the areas of inflammation. The differential diagnoses were infectious uveitis, Vogt-Koyanagi-Harada-like syndrome or masquerade retinopathy. After a full work-up, the patient was diagnosed with unilateral posterior uveitis. The patient responded to topical steroid therapy with improved vision (20/30). Uveitis is listed as an adverse effect on the prescribing list of the drug Opdivo^®. Although not reported before, our case demonstrated unilateral involvement. We thus recommend clinicians to be wary after complaints of side effects from their patients; ocular toxicities should be considered.

Keywords: immune-checkpoint inhibitors; immunotherapy-related adverse events; malignant melanoma metastasis; opdivo nivolumab; uveitis.

Figure 1. Fundus photography at the onset of ocular symptoms

Figure 2. Optical coherence tomography (OCT) showed macular oedema at the onset of ocular symptoms

OCT examination revealed right eye intra-retinal and sub-retinal fluid and multiple hyperreflective inner retinal round foci in inflammation (arrows)

Figure 3. Fundus photography six months after the onset of ocular symptoms

Figure 4. Optical coherence tomography (OCT) six months after the onset of ocular symptoms showing resolving macular oedema

OCT examination revealed decrease in the previously seen intra-retinal and sub-retinal fluid and fewer hyperreflective inner retinal round foci (arrows)