Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6536-6542
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6536
Choroidal thickening with serous retinal detachment in BRAF/MEK inhibitor-induced uveitis: A case report
Peter Kiraly, Alenka Lavrič Groznik, Nataša Vidovič Valentinčič, Polona Jaki Mekjavić, Mojca Urbančič, Janja Ocvirk, Tanja Mesti
Peter Kiraly, Alenka Lavrič Groznik, Nataša Vidovič Valentinčič, Polona Jaki Mekjavić, Mojca Urbančič, Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, SI-1000 Ljubljana, Slovenia
Peter Kiraly, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 9DU, Oxford, United Kingdom
Janja Ocvirk, Tanja Mesti, Department of Medical Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
Author contributions: Kiraly P was the patient’s ophthalmologist, collected the patient’s clinical data, reviewed the literature, designed the report, and wrote the paper; Groznik AL, Valentinčič NV, Mekjavić PJ, and Urbančič M were the patient’s ophthalmologists and contributed to manuscript drafting; Mesti T and Ocvirk J were the patient’s oncologists and contributed to manuscript drafting, writing, and editing.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tanja Mesti, PhD, Assistant Professor, Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloška 2, Ljubljana 1000, Slovenia. tmesti@onko-i.si
Received: September 13, 2021
Peer-review started: September 13, 2021
First decision: January 10, 2022
Revised: November 12, 2021
Accepted: May 8, 2022
Article in press: May 8, 2022
Published online: July 6, 2022
Abstract
BACKGROUND

Immune checkpoint inhibitors have revolutionized the treatment of patients with unresectable metastatic malignant melanoma. In addition to systemic side effects, several usually mild ocular adverse effects have been reported. We report a case of rarely reported vision-threatening bilateral panuveitis with serous retinal detachment, thickened choroid, and chorioretinal folds associated with dabrafenib and trametinib targeted therapy for B-Raf proto-oncogene serine/threonine kinase (BRAF) mutant metastatic cutaneous melanoma.

CASE SUMMARY

A 59-year-old female patient with metastatic melanoma treated with dabrafenib and trametinib presented with blurry vision and central scotoma lasting for 3 d in both eyes. Clinical examination and multimodal imaging revealed inflammatory cells in the anterior chamber, mild vitritis, bullous multiple serous retinal detachments, and chorioretinal folds in both eyes. Treatment with dabrafenib and trametinib was suspended, and the patient was treated with topical and intravenous corticosteroids followed by oral corticosteroid treatment with a tapering schedule. One and a half months after the disease onset, ocular morphological and functional improvement was noted. Due to the metastatic melanoma dissemination, BRAF/mitogen-activated protein kinase inhibitors were reintroduced and some mild ocular adverse effects reappeared, which later subsided after receiving oral corticosteroids.

CONCLUSION

Patients on combination therapy with dabrafenib and trametinib may rarely develop severe bilateral panuveitis with a good prognosis. Further studies have to establish potential usefulness of ophthalmological examination for asymptomatic patients. Furthermore, appropriate guidelines for managing panuveitis associated with dabrafenib and trametinib should be established.

Keywords: Metastatic melanoma treatment, BRAF/MEK inhibitors, Dabrafenib and trametinib, Ocular adverse effects, Bilateral panuveitis, Case report

Core Tip: The effectiveness of B-Raf proto-oncogene serine/threonine kinase (BRAF)/mitogen-activated protein kinase (MEK) inhibitor therapy in terms of prolonging survival has revolutionized the treatment of metastatic melanoma and other cancers. Consequently, widespread use in several metastatic cancers could be anticipated in the future. Therefore, all possible adverse effects should be described. We report a case of very rare and severe bilateral panuveitis with transient visual loss associated with treatment of metastatic malignant melanoma. The purpose of our case report is to raise awareness of possible severe bilateral panuveitis associated with immune checkpoint inhibitor therapy and to show that ocular symptoms subside with BRAF/MEK inhibitor discontinuation and/or systemic corticosteroids. Further studies should establish guidelines for panuveitis management and evaluate the importance of ophthalmological examination for asymptomatic patients.