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Pembrolizumab-Induced Nodular Posterior Scleritis
Calvin L McNelly1, Asghar A Haider1,2, Robert C Wann1,2
1University of Alabama Callahan Eye Hospital and Clinics, Birmingham, AL, USA.
Journal of Vitreoretinal Diseases
|November 6, 2023
Summary
Pembrolizumab, used to treat tumors, can cause posterior scleritis, an eye inflammation. This case report highlights the importance of recognizing this rare side effect, which resolved after treatment adjustment.
Area of Science:
- Ophthalmology
- Oncology
- Immunology
Background:
- Pembrolizumab is an immune checkpoint inhibitor used in cancer therapy.
- Tumor recurrence can necessitate treatment with agents like pembrolizumab.
- Ocular complications associated with immunotherapy are increasingly recognized.
Observation:
- A 20-year-old female patient with a history of ependymoma developed painless blurred vision.
- Fundoscopy revealed a solitary amelanotic choroidal lesion with subretinal fluid.
- Ultrasonography indicated nodular posterior scleritis and fluid in the Tenon capsule.
Findings:
- The patient's symptoms and choroidal lesion resolved completely after systemic steroid treatment and pembrolizumab discontinuation.
- This suggests a direct link between pembrolizumab therapy and the development of posterior scleritis.
- Histopathological analysis was not performed, but clinical and imaging findings were consistent with scleritis.
Implications:
- Posterior scleritis should be considered in patients on pembrolizumab presenting with unexplained ocular symptoms.
- Awareness of this potential ocular complication is crucial for timely diagnosis and management.
- Further research is needed to elucidate the mechanisms underlying immunotherapy-induced ocular inflammation.
