[Orbital myositis associated with ipilimumab].

Area of Science:

• Oncology
• Immunology
• Ophthalmology

Background:

• Ipilimumab, a CTLA-4 inhibitor, improves survival in metastatic melanoma but can cause immune-related adverse events.
• Dysimmune toxicities are common with ipilimumab, though ophthalmic manifestations are rare.

Observation:

• A female patient developed painful diplopia and proptosis three days after her fourth ipilimumab infusion for metastatic melanoma.
• Clinical exam revealed left abduction deficit; orbital MRI showed left lateral rectus enlargement with contrast enhancement.
• Exclusion of thyroid eye disease, inflammatory processes, cellulitis, and metastases was confirmed through extensive work-up.

Findings:

• This is the first reported case of orbital myositis as an adverse event associated with anti-CTLA-4 therapy.
• The temporal relationship and adverse event profile strongly suggest ipilimumab as the cause of orbital myositis.
• High-dose oral steroid treatment resulted in complete clinical recovery within days.

Implications:

• Orbital myositis is a potential, albeit rare, ophthalmic toxicity of ipilimumab treatment.
• Early recognition and prompt treatment with corticosteroids can effectively manage this immune-related adverse event.
• Further research is needed to determine if immune-related adverse events correlate with ipilimumab treatment response.