ニボルマブ投与後にぶどう膜炎を発症した1例

A case of uveitis following systemic treatment with nivolumab

要約　目的：腎細胞癌の術後に生じた全身転移に対するニボルマブ投与後にぶどう膜炎が生じた1症例の報告。

症例：45歳男性の左腎癌に対する腎摘出後に，リンパ節と肝臓に転移を認めた。ニボルマブを全身投与し，その7週後に両眼の充血と瘙痒感が生じ，当科を受診した。

所見と経過：矯正視力は右0.3，左0.5で，両眼に前房の炎症所見，虹彩後癒着，漿液性網膜剝離があり，蛍光眼底造影で原田病と似た所見があった。HLAはDR4陽性であった。ニボルマブによるぶどう膜炎を疑い，ニボルマブの投与中止とステロイド点眼とテノン囊下注射を開始し，ステロイド内服を追加した。眼所見は改善し，視力は3か月後に右1.2，左1.5になった。ステロイド内服を継続しながらニボルマブの投与を再開した。以後7か月後の現在までぶどう膜炎の再発はない。

結論：腎細胞癌の術後に生じた全身転移に対するニボルマブ投与後に原田病に類似するぶどう膜炎が発症した。ステロイドの局所と全身投与でぶどう膜炎は寛解した。

Abstract　Purpose：To report a case of bilateral uveitis following systemic treatment with nivolumab for extraocular malignancy.

Case：A 45-year-old male presented with blurring and hyperemia in both eyes. He had received excision of left kidney for carcinoma. He started treatment with systemic nivolumab for metastasis to the liver and lymph nodes since 7 weeks before.

Findings and Clinical Course：Corrected visual acuity was 0.3 right and 0.5 left. Both eyes showed findings of inflammation in the anterior chamber, posterior synechiae, and serous retinal detachment. Fluorescein angiography showed findings simulating Vogt-Koyanagi-Harada（VKH）disease. HLA was positive for DR4. Under diagnosis of uveitis secondary to systemic nivolumab, he was treated by withdrawal of systemic nivolumab, and topical corticosteroid. Systemic corticosteroid was started later. Ocular lesions improved with visual acuity of 1.2 right and 1.5 left 3 months later. Systemic nivolumab was started again under continuation of systemic corticosteroid. He has been doing well for 7 months until present.

Conclusion：Bilateral uveitis simulating VKH disease developed following systemic treatment with nivolumab for extraocular malignancy. Ocular lesions subsided following treatment with topical and systemic corticosteroid.