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Vol.64 No.1 contents | Japanese/English |
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- Case Report -
A Case of Optic Neuritis and Posterior Uveitis with a Nodular Lesion in a Patient with Non-small-cell Lung Cancer Treated with Nivolumab Plus Ipilimumab Combined with Pemetrexed Plus Carboplatin
Satoshi Hanzawa1, Tatsuo Kawahara1, Yoshihisa Nukui11Department of Respiratory Medicine, Shuuwa General Hospital, Japan
Background. Uveitis induced by immune checkpoint inhibitors (ICIs) is a rare immune-related adverse event (irAE). We herein report a patient who presented with unilateral uveitis complicated with a nodular lesion mimicking metastasis of lung cancer to the retina and with opposite-eye uveitis one month after the initiation of corticosteroid therapy. Case. A 59-year-old woman suffered recurrence of lung adenocarcinoma after right upper lobectomy and started nivolumab plus ipilimumab therapy combined with pemetrexed plus carboplatin. The patient presented with sudden visual impairment in the left eye seven weeks after the initiation of chemotherapy. She was diagnosed with optic neuritis and posterior uveitis. Optical coherence tomography showed that the uveitis was unilateral and complicated with not only serous detachment of the retina but also a nodular lesion. These findings raised the possibility that the uveitis had been induced by metastasis of lung cancer to the retina, although it might also have been an irAE due to ICI therapy. To restore her vision, we started treatment with corticosteroids. The serous detachment and nodular lesion disappeared, but the patient developed vision impairment in the right eye after the dose of corticosteroids had been tapered. The vision in the right eye was restored after the dosage of corticosteroids was increased, but the vision in the left eye was only partly recovered. The patient consequently used an occluder lens for the left eye, with her visual capability left entirely to the right eye. Conclusion. Uveitis induced by ICIs can occur laterally or be complicated with a nodular lesion, making a diagnosis challenging. Uveitis induced by ICIs can cause severe vision impairment and affect the quality of life.
key words: Immune checkpoint inhibitor, Immune-related adverse event, Serous detachment of the retina, Uveitis
Received: June 23, 2023
Accepted: September 20, 2023
JJLC 64 (1): 17-21, 2024
