Cutaneous Cell-Mediated Delayed Hypersensitivity to Intravitreal Bevacizumab

Area of Science:

• Ophthalmology
• Oncology
• Immunology

Background:

• Intravitreal bevacizumab is used for various ocular conditions, including macular edema and radiation retinopathy.
• Dermatologic side effects are common with intravenous bevacizumab but rare with intravitreal administration.
• A significant dose difference likely explains the lower incidence of side effects with intravitreal use.

Observation:

• A patient with choroidal melanoma developed pruritus and rashes after multiple intravitreal bevacizumab injections.
• The hypersensitivity reaction manifested as a delayed-type, Type-IV reaction.
• Symptoms improved upon discontinuation of intravitreal bevacizumab and did not recur with intravitreal aflibercept.

Findings:

• This case highlights a potential systemic autoimmune reaction to intravitreal bevacizumab, presenting as delayed hypersensitivity.
• The reaction's delayed onset and resolution upon drug cessation are key diagnostic features.
• Alternative treatments like intravitreal aflibercept may be suitable for patients experiencing such reactions.

Implications:

• Ophthalmologists should be vigilant for potential systemic side effects of intravitreal bevacizumab, including hypersensitivity reactions.
• Awareness of this delayed reaction can aid in timely diagnosis and management.
• This finding contributes to understanding the immunogenicity of intravitreal anti-VEGF agents.