ニボルマブ投与後にVogt-小柳-原田病に類似した汎ぶどう膜炎を発症した1例

A case of uveitis simulating Vogt-Koyanagi-Harada disease following peroral nivolumab for pharyngeal malignant melanoma

要約　目的：ニボルマブ投与後に発症したVogt-小柳-原田病（原田病）様の汎ぶどう膜炎の報告

症例：77歳，男性

所見と経過：咽頭悪性黒色腫に対しニボルマブを投与された翌日に，両眼の視力低下を自覚し当科を初診した。両眼の前房内に炎症細胞とフィブリン，硝子体混濁，脈絡膜皺襞を認めた。蛍光眼底造影検査で視神経乳頭の過蛍光と多発する点状漏出がみられ，汎ぶどう膜炎と診断し，プレドニゾロン20mgの内服を開始した。治療開始3日目に炎症所見の悪化と漿液性網膜剝離を認め，原田病様の病態を疑い，両眼にトリアムシノロンテノン囊下注射を施行したところ，1か月後にぶどう膜炎の改善を得た。

結論：ニボルマブの免疫関連有害事象として原田病様の汎ぶどう膜炎を生じる可能性があり，留意が必要である。

Abstract　Purpose：To report a case of bilateral uveitis simulating Vogt-Koyanagi-Harada（VKH）disease following peroral nivolumab for pharyngeal malignancy.

Case：A 77-year-old man presented with blurring of vision in both eyes. He had received peroral nivolumab for pharyngeal malignant melanoma the day before.

Findings and Clinical Course：Corrected visual acuity was 0.7 in either eye. Both eyes showed cells in the anterior chamber, vitreous opacity, and choroidal folds. Fluorescein angiography showed hyperfluorescence of the optic disc and multiple patchy leakage, leading to the tentative diagnosis of panuveitis. He started receiving peroral 20 mg prednisolone. Findings of uveitis became more manifest 3 days later. Serous retinal detachment also appeared. He was suspected of VKH disease and started receiving subtenon injection of triamcinolone. The uveitis subsided one month later.

Conclusion：This case illustrates that findings simulating VKH disease may appear following systemic nivolumab as an immune-related adverse event.