Case Report: Chloroquine Induced Keratopathy – Toxicity from Systemic Use

Daniel Choi,Taylor Linaburg,Stephen Orlin,Vivian Lee

doi:10.11648/j.ajcem.20200805.11

Abstract

The application of chloroquine has been expanded over time from the treatment of malaria to a variety of connective tissue, inflammatory, and dermatologic disorders. More recently, chloroquine and its derivative, hydroxychloroquine, have been investigated for its possible application against SARS-CoV-2 due to their antiviral properties. We present a case of a patient receiving chloroquine as adjuvant therapy for glioblastoma multiforme who developed significant keratopathy and review this overlooked entity in view of the resurgence of this enduring medication. A 48-year-old woman with a history of Marfan syndrome presented with a five-day history of pain and discomfort in her right eye. She had a history of glioblastoma multiforme that had been treated with surgical resection, radiation, and chemotherapy and was currently undergoing adjuvant treatment with chloroquine and cimetidine. Her exam was notable for decreased visual acuity, bilateral epithelial erosions, multiple subepithelial white dots in a whorl-like distribution, and decreased corneal sensation. These corneal changes reversed following cessation of chloroquine. While chloroquine related retinopathy is reported frequently in the literature, the corneal changes related to chloroquine have been less frequently discussed. With the resurgence of interest in using chloroquine and hydroxychloroquine as therapy for SARS-CoV-2 due to their promising in-vitro activity against the virus [1, 2], corneal toxicity is an important side effect to identify and monitor.

Highlights

Hydroxychloroquine and chloroquine are two well-known medications that have been used for many decades to treat malaria and a variety of rheumatologic and inflammatory conditions
We present a case of a patient receiving chloroquine as adjuvant therapy for glioblastoma multiforme who developed significant keratopathy
The earliest corneal changes have been documented after 8 weeks of chloroquine use and in up to 95% of patients [8]

Summary

Introduction

Hydroxychloroquine and chloroquine are two well-known medications that have been used for many decades to treat malaria and a variety of rheumatologic and inflammatory conditions. With the recent development of SARS-CoV-2 virus infecting nearly 8 million people worldwide, the scientific community has taken a renewed interest in chloroquine and hydroxychloroquine for their antiviral properties. Daniel Choi et al.: Case Report: Chloroquine Induced Keratopathy – Toxicity from Systemic Use irreversible retinal toxicity is a well-known entity that was described as early as 1959 [7], chloroquine related corneal findings are less well known. Drug deposition in the cornea has been observed in as many as 95% of patients taking the drug [8], these changes have been less frequently discussed, likely as a result of an overall decrease in the use of chloroquine [9] and the relatively benign nature of the keratopathy [10]. Discussion of ocular surface findings is significant as current treatment protocols targeting SARS-CoV-2 involve high doses of chloroquine/hydroxychloroquine. We present a case of a patient receiving chloroquine as adjuvant therapy for glioblastoma multiforme who developed significant keratopathy

Case Report

Findings

Discussion

Conclusion