Bilateral uveitis associated with nivolumab therapy for metastatic non-small cell lung cancer

Christopher R Dermarkarian; Nimesh A Patel; Victor M Villegas; J William Harbour

doi:10.1016/j.ajoc.2020.100691

Bilateral uveitis associated with nivolumab therapy for metastatic non-small cell lung cancer

Am J Ophthalmol Case Rep. 2020 Apr 7:18:100691. doi: 10.1016/j.ajoc.2020.100691. eCollection 2020 Jun.

Authors

Christopher R Dermarkarian¹, Nimesh A Patel², Victor M Villegas², J William Harbour^{2

3}

Affiliations

¹ Cullen Eye Institute, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
² Bascom Palmer Eye Institute And, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA.
³ Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine 900 NW 17th Street, Miami, FL, 33136, USA.

Abstract

Purpose: To report a case of bilateral uveitis secondary to intravenous nivolumab therapy in a patient with stage IV non-small cell lung cancer.

Observations: A 53-year-old male with stage IV non-small cell lung cancer presented with gradual onset of blurry vision in the left eye for nine days after completion of the first cycle of intravenous nivolumab chemotherapy. At initial presentation, best-corrected visual acuity was 20/25 in the right eye and 20/30 in the left eye. Slit lamp biomicroscopy examination of the left eye showed temporal injection of the conjunctiva and sclera, granulomatous keratic precipitates, and vitreous cells in the posterior segment. Imaging studies, including fundus photography, fluorescein angiography, fundus autofluorescence, optical coherence tomography, iridocyanine green angiography, and B scan ultrasonography, demonstrated acute inflammation in the posterior segment of the right eye and anterior, intermediate and posterior segments of the left eye. Nivolumab was discontinued and the patient received a course of corticosteroids resulting in resolution of visual complaints. The patient subsequently developed elevated and sustained intraocular pressures and decreased visual acuity in the left eye secondary to treatment complications. The patient was then lost to follow-up.

Conclusions and importance: To our best knowledge, this is a rare case of bilateral uveitis secondary to intravenous nivolumab use and the sixteenth reported case of nivolumab-induced uveitis. Physicians should be aware of possible ocular complications associated with the use of nivolumab and provide prompt treatment when necessary.

Keywords: Immunotherapy; Nivolumab; Non-small cell lung cancer; Panuveitis.

Publication types

Case Reports

Grants and funding

P30 EY014801/EY/NEI NIH HHS/United States