Cemiplimab-Induced Vogt-Koyanagi-Harada-Like Syndrome in a Patient With Cutaneous Squamous Cell Carcinoma of the Lower Back.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Shapoo Nidha, Rehman Abdul, Mattana Joseph, Jen-Chin Wang, Gotlieb Vladimir
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Abstract

Cemiplimab is a programmed death receptor-1 inhibitor that has been approved for the treatment of advanced cutaneous squamous cell carcinoma (CSCC). The immune-related adverse events most commonly reported with cemiplimab are thyroiditis, pneumonitis, and hepatitis. Ocular adverse events have been rarely reported. We present a rare case of Vogt-Koyanagi-Harada (VKH)-like syndrome in a patient with CSCC being treated with cemiplimab. A 53-year-old woman presented with bilateral progressive visual disturbances, eye pain, and headache for 4 weeks after 4 cycles of neo-adjuvant cemiplimab therapy for stage IV CSCC of the lower back. The detailed ophthalmologic evaluation established the diagnosis of VKH-like syndrome with panuveitis, subretinal fibrosis, and exudative retinal detachment. The patient received high-dose intravenous and topical steroids followed by a gradual taper of oral steroids over 6 months. Cemiplimab was discontinued. There was significant improvement in her symptoms with the resolution of subretinal fluid, choroidal elevations, and retinal detachment. VKH-like syndrome is an immune-mediated disorder that affects pigmented structures and is a significant cause of noninfectious uveitis. Drug-related uveitis has been seen more commonly with immune checkpoint inhibitors than with other drug classes and can occur anytime during the treatment. The mainstay of treatment of VKH-like syndrome is high-dose intravenous corticosteroids. In resistant cases, immunosuppressive therapies and biological agents are beneficial. This case highlights the importance of prompt recognition of VKH-like syndrome associated with cemiplimab, enabling timely intervention to prevent permanent vision loss.

西米单抗诱导下背部皮肤鳞状细胞癌患者的vogt - koyanagi - harada样综合征
Cemiplimab是一种程序性死亡受体-1抑制剂,已被批准用于治疗晚期皮肤鳞状细胞癌(CSCC)。最常报道的与免疫相关的不良事件是甲状腺炎、肺炎和肝炎。眼部不良事件鲜有报道。我们报告一例罕见的Vogt-Koyanagi-Harada (VKH)样综合征的CSCC患者正在接受西米单抗治疗。一名53岁的女性在接受4个周期的新辅助治疗后出现双侧进行性视力障碍、眼痛和头痛,持续4周。详细的眼科评估确定了vkh样综合征伴全葡萄膜炎、视网膜下纤维化和渗出性视网膜脱离的诊断。患者接受大剂量静脉注射和局部类固醇,随后在6个月内逐渐减少口服类固醇。停用了西米单抗。随着视网膜下积液、脉络膜升高和视网膜脱离的消退,她的症状有了显著改善。vkh样综合征是一种免疫介导的疾病,影响色素结构,是非感染性葡萄膜炎的重要原因。药物相关性葡萄膜炎在免疫检查点抑制剂中比在其他药物类别中更常见,并且可以在治疗期间的任何时间发生。治疗vkh样综合征的主要方法是大剂量静脉注射皮质类固醇。在耐药病例中,免疫抑制治疗和生物制剂是有益的。本病例强调了及时识别与头孢米单抗相关的vkh样综合征的重要性,以便及时干预以防止永久性视力丧失。
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来源期刊
CiteScore
1.90
自引率
0.00%
发文量
165
审稿时长
12 weeks
期刊介绍: The AFMR is committed to enhancing the training and career development of our members and to furthering its mission to facilitate the conduct of research to improve medical care. Case reports represent an important avenue for trainees (interns, residents, and fellows) and early-stage faculty to demonstrate productive, scholarly activity.
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