흉막의 악성 중피종에서 면역관문억제제 병합 치료 후 발생한 보크트-고야나기-하라다 유사 증후군: 증례보고

초록

Purpose: To report a case of Vogt-Koyanagi-Harada-like syndrome that developed during nivolumab and ipilimumab combination immunotherapy in a patient with malignant pleural mesothelioma. Case summary: A 40-year-old female diagnosed with malignant pleural mesothelioma presented with headache and bilateral visual disturbance after receiving nivolumab and ipilimumab combination immunotherapy. Her best-corrected visual acuity was 0.6, and the intraocular pressure was 14 mmHg in both eyes. Fundus examination revealed multiple serous retinal detachment with chorioretinal folding in both eyes. The patient was diagnosed with Vogt-Koyanagi-Harada-like syndrome in both eyes, and immunotherapy with nivolumab and ipilimumab was immediately discontinued. Systemic intravenous steroid therapy was initiated, and sub-Tenon’s triamcinolone acetonide injection was administered in both eyes. After one month, the serous retinal detachment and chorioretinal folding decreased, and visual acuity improved in both eyes. Oral and eye drops of steroids were gradually tapered and discontinued after three months. However, anterior uveitis recurred in the left eye one month after discontinuation of steroids, which subsequently improved with topical steroid therapy. Conclusions: The possibility of uveitis complication, such as Vogt-Koyanagi-Harada-like syndrome, should be considered in patients receiving immunotherapy with nivolumab and ipilimumab.

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