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Nivolumab-Induced Ulcerative Keratitis-A Case Report.
Gergely Losonczy1, Marlies Gijs2, Rudy M M A Nuijts2
1Department of Ophthalmology, Zuyderland-Eyescan BV, Zuyderland Hospital, Sittard-Geleen, the Netherlands ; and.
Cornea
|August 23, 2020
Summary
Nivolumab treatment can cause ulcerative keratitis, an autoimmune eye condition. Topical steroid eye drops effectively treat this condition and prevent recurrence during cancer therapy.
Area of Science:
- Ophthalmology
- Oncology
- Immunology
Background:
- Nivolumab, an immune checkpoint inhibitor, is used to treat metastatic melanoma.
- Ocular side effects, including dry eye and keratitis, have been reported with nivolumab therapy.
Observation:
- A patient on nivolumab developed severe ulcerative keratitis unresponsive to conventional treatment.
- Tear fluid analysis revealed elevated levels of inflammatory cytokines and matrix metalloproteinases.
Findings:
- Topical corticosteroid therapy led to rapid resolution of the corneal epithelial defect.
- Intermittent steroid use prevented recurrence of keratitis during continued nivolumab treatment.
- The patient tested negative for Sjögren disease-related autoantibodies, suggesting a nivolumab-specific mechanism.
Implications:
- Nivolumab may induce a localized autoimmune ocular surface disorder.
- Topical steroids are a viable treatment for nivolumab-induced ulcerative keratitis.
- Monitoring and management of ocular surface toxicity are crucial for patients receiving nivolumab.
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