Bilateral uveitis and macular edema induced by Nivolumab: a case report

doi:10.1186/s12886-017-0611-3

Case Reports

. 2017 Dec 1;17(1):227.

doi: 10.1186/s12886-017-0611-3.

Bilateral uveitis and macular edema induced by Nivolumab: a case report

Claire Theillac^{1

2}, Morgane Straub^{3

4}, Anne-Laure Breton^{5

3}, Luc Thomas^{5

3

6}, Stéphane Dalle^{5

3

6}

Affiliations

¹ Department of Dermatology, Service de dermatologie, ImmuCare, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 chemin du grand revoyet, Pierre Bénite Cedex, France. claire.theillac@chu-lyon.fr.
² Université Claude Bernard Lyon 1, Lyon, France. claire.theillac@chu-lyon.fr.
³ Université Claude Bernard Lyon 1, Lyon, France.
⁴ Department of Ophthalmology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France.
⁵ Department of Dermatology, Service de dermatologie, ImmuCare, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 chemin du grand revoyet, Pierre Bénite Cedex, France.
⁶ Cancer Research Center of Lyon, Lyon, France.

PMID: 29195497
PMCID: PMC5709862
DOI: 10.1186/s12886-017-0611-3

Case Reports

Bilateral uveitis and macular edema induced by Nivolumab: a case report

Claire Theillac et al. BMC Ophthalmol. 2017.

. 2017 Dec 1;17(1):227.

doi: 10.1186/s12886-017-0611-3.

Authors

Claire Theillac^{1

2}, Morgane Straub^{3

4}, Anne-Laure Breton^{5

3}, Luc Thomas^{5

3

6}, Stéphane Dalle^{5

3

6}

Affiliations

¹ Department of Dermatology, Service de dermatologie, ImmuCare, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 chemin du grand revoyet, Pierre Bénite Cedex, France. claire.theillac@chu-lyon.fr.
² Université Claude Bernard Lyon 1, Lyon, France. claire.theillac@chu-lyon.fr.
³ Université Claude Bernard Lyon 1, Lyon, France.
⁴ Department of Ophthalmology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France.
⁵ Department of Dermatology, Service de dermatologie, ImmuCare, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 chemin du grand revoyet, Pierre Bénite Cedex, France.
⁶ Cancer Research Center of Lyon, Lyon, France.

PMID: 29195497
PMCID: PMC5709862
DOI: 10.1186/s12886-017-0611-3

Abstract

Background: Nivolumab is a fully human antibody which is routinely used at first therapy for metastatic melanoma. Usually, side effects are immune-related adverse events. We report a case of a man who developed bilateral anterior uveitis and macular serous retinal detachment during nivolumab treatment for metastatic melanoma.

Case presentation: A man on nivolumab treatment for a leg melanoma with duodenal and lymph nodes metastases developed a sudden bilateral visual acuity impairment and bilateral non-painfull redness eyes several days after the third infusion. The clinical examination showed a significant decreased of the visual acuity. Slit lamp examination revealed the presence of bilateral granulomatous keratic precipitates, anterior chamber cells +++, bilateral synechiae, bilateral papilledema and macular edema associated with serous retinal detachment in the left eye. The anti-Programmed cells Death-1 was stopped and a topical corticosteroid treatment was administrated. After 8 days of topical corticosteroid treatment visual acuity was worsening with similar optical coherence tomography examination. An oral corticosteroid treatment was started. Evolution was favorable with a decrease of ocular inflammation and a complete visual acuity recovery after 3 weeks. Nivolumab was re-initiated.

Conclusions: This is the second clinical report of bilateral anterior uveitis associated with macular serous retinal detachment related to anti-PD-1 treatment, and the first with nivolumab. Cases of uveitis were reported several times. Although rare, ophthalmologic manifestations that are rapidly recognized and adequately managed can be treated.

Keywords: Immunotherapy; Macular edema; Melanoma; Side-effect; Uveitis.

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Figures

**Fig. 1**
Bilateral slit lamp examination: OD and OS: posterior synechiae (red arrows)

**Fig. 2**
Right eye fluorescein angiography with papillitis (early stage 2:39 min)

**Fig. 3**
Bilateral optical coherence tomography: OD: normal foveolar profile before and after treatment, OS: retrofoveal subretinal detachment before and after treatment

See this image and copyright information in PMC

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References

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1. Schmid-Bindert G, Jiang T. First-line nivolumab (anti-PD-1) monotherapy in advanced NSCLC: the story of immune checkpoint inhibitors and ‘the sorcerers apprentice. Transl Lung Cancer Res. 2015;4(3):215–216. - PMC - PubMed
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1. Day D, Hansen AR. Immune-related adverse events associated with immune checkpoint inhibitors. BioDrugs Clin Immunother Biopharm Gene Ther. 2016;30(6):571–584. - PubMed
1. Chen L, Han X. Anti-PD-1/PD-L1 therapy of human cancer: past, present, and future. J Clin Invest. 2015;125(9):3384–3391. doi: 10.1172/JCI80011. - DOI - PMC - PubMed

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[1] Robert C, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320–330. doi: 10.1056/NEJMoa1412082. - DOI - PubMed

[2] Robert C, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320–330. doi: 10.1056/NEJMoa1412082. - DOI - PubMed

[3] Schmid-Bindert G, Jiang T. First-line nivolumab (anti-PD-1) monotherapy in advanced NSCLC: the story of immune checkpoint inhibitors and ‘the sorcerers apprentice. Transl Lung Cancer Res. 2015;4(3):215–216. - PMC - PubMed

[4] Schmid-Bindert G, Jiang T. First-line nivolumab (anti-PD-1) monotherapy in advanced NSCLC: the story of immune checkpoint inhibitors and ‘the sorcerers apprentice. Transl Lung Cancer Res. 2015;4(3):215–216. - PMC - PubMed

[5] Larkin J, et al. Efficacy and safety of Nivolumab in patients with BRAF V600 mutant and BRAF wild-type advanced melanoma: a pooled analysis of 4 clinical trials. JAMA Oncol. 2015;1(4):433–440. doi: 10.1001/jamaoncol.2015.1184. - DOI - PubMed

[6] Larkin J, et al. Efficacy and safety of Nivolumab in patients with BRAF V600 mutant and BRAF wild-type advanced melanoma: a pooled analysis of 4 clinical trials. JAMA Oncol. 2015;1(4):433–440. doi: 10.1001/jamaoncol.2015.1184. - DOI - PubMed

[7] Day D, Hansen AR. Immune-related adverse events associated with immune checkpoint inhibitors. BioDrugs Clin Immunother Biopharm Gene Ther. 2016;30(6):571–584. - PubMed

[8] Day D, Hansen AR. Immune-related adverse events associated with immune checkpoint inhibitors. BioDrugs Clin Immunother Biopharm Gene Ther. 2016;30(6):571–584. - PubMed

[9] Chen L, Han X. Anti-PD-1/PD-L1 therapy of human cancer: past, present, and future. J Clin Invest. 2015;125(9):3384–3391. doi: 10.1172/JCI80011. - DOI - PMC - PubMed

[10] Chen L, Han X. Anti-PD-1/PD-L1 therapy of human cancer: past, present, and future. J Clin Invest. 2015;125(9):3384–3391. doi: 10.1172/JCI80011. - DOI - PMC - PubMed

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