Purpose: We report the case of a patient with uveitis and depigmentation associated with the administration of anti-programmed cell death 1 (PD-1) monoclonal antibody (mAb) for the treatment of metastatic melanoma.
Case: A 59-year-old man visited an ophthalmologist for blurred vision 18 days after the initiation of nivolumab therapy for melanoma on the sole of the foot with metastasis to the lung. Slit lamp examination showed inflammatory cells in the anterior chamber and fibrin formation and posterior synechia in both eyes. The results of fundus examination using fluorescein angiography and optical coherence tomography were unremarkable in both eyes. Human leukocyte antigen (HLA) typing was positive for HLA-B51 and HLA-DR4. Nivolumab therapy was continued, and subconjunctival injection and ocular instillation of a corticosteroid improved iritis. However, from 2 months after starting nivolumab therapy, poliosis and alopecia on the scalp, and from 20 months, sun-set glow fundus were observed. At the end of 14 consecutive cycles of nivolumab therapy, there was no aggravation of the metastatic lesion in the lung and no recurrence of iritis.
Conclusions: It is speculated that nivolumab enhanced immunity via suppression of the PD-1 co-inhibitory pathway from antigen-presenting cells to T cells, resulting in uveitis. Care must be taken as the number of patients with uveitis may increase with the widespread use of anti-PD-1 mAb therapy in the future.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 121: 712-718, 2017.