転移性黒色腫患者におけるイピリムマブに関連した重度の両側性脈絡網膜症

To report a rare case of severe bilateral chorioretinopathy associated with ipilimumab in a patient with metastatic melanoma, highlighting the ocular toxicities that may arise from immune checkpoint inhibitors.

A 38-year-old woman receiving ipilimumab (3 mg/kg every 3 weeks) for metastatic melanoma presented with painless bilateral vision loss following her third dose. Clinical assessment included visual acuity testing, fundus examination, fluorescein angiography (FA), and optical coherence tomography (OCT) to evaluate retinal changes. The ipilimumab treatment was discontinued, but the patient refused corticosteroid therapy.

Fundus examination and OCT revealed bilateral serous retinal detachments with retinal pigment epithelium (RPE) detachment. FA demonstrated multiple pinpoint leakage areas at the RPE level. Over a three-month follow-up period, visual acuity further declined, resulting in total vision loss in one eye and persistent bilateral serous detachments despite cessation of ipilimumab.

This case highlights the potential for severe, irreversible vision loss due to ipilimumab-associated chorioretinopathy, underscoring the importance of early ophthalmological assessment and continuous monitoring in patients undergoing immune checkpoint inhibitor therapy. Early recognition and intervention are critical, especially when systemic corticosteroids are not administered.