Abstract

Inflammatory eye disease has been reported as a side effect with Nivolumab. We report a case of a 92-year-old woman presenting with bilateral and simultaneous keratitis and uveitis in the setting of recurring infusions of nivolumab for metastatic melanoma. The patient underwent successful coordinated treatment of both eyes coinciding with ongoing systemic infusion treatments with ophthalmic topical medications alone. The interest of this case resides in the simultaneous nature of presentation of eye inflammation both internally and of the ocular surface. Prior case reports have cited uveitis or ocular surface disease, however not in simultaneous fashion. Clinicians should raise their index of suspicion of side effects of nivolumab systemic infusion for any vision or eye symptom changes around the timing of treatment.

Highlights

  • Nivolumab is an anti-programmed cell death protein-1 monoclonal antibody in an emerging class of anti-tumor therapies inhibiting T-cell immune checkpoints [1]

  • Nivolumab is approved by the Food and Drug Administration (FDA) for treatment of patients with non-surgical or metastatic melanoma, metastatic non-small cell lung cancer, renal cell carcinoma, classical Hodgkin’s lymphoma, squamous cell carcinoma of the head and neck, and urothelial carcinoma [2]

  • We present this as a case of bilateral and simultaneous keratitis and uveitis in the setting of nivolumab infusions for metastatic melanoma

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Summary

Introduction

Medication [3,4,5,6]. We present this as a case of bilateral and simultaneous keratitis and uveitis in the setting of nivolumab infusions for metastatic melanoma. The patient reported progressive vision decrease over the past 1.5 weeks without pain, redness or light sensitivity She self-reported a history of normal eye exams other than age related lens changes diagnosed at a separate facility in the past year. Given the rapid therapeutic response to topical therapy and need for ongoing systemic cancer therapy, a plan of pulsing topical steroids to six times daily one day prior to nivolumab infusion with a taper and follow up eye exam the same week of the infusion was initiated. This modality of therapy was used with each subsequent cycle of systemic therapy. The patient was converted to vemurafenib oral therapy according to medical decisions independent from the ocular course

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