Figure 1 | Scientific Reports

Figure 1

From: HLA-DRB1*04:05 is involved in the development of Vogt–Koyanagi–Harada disease-like immune-related adverse events in patients receiving immune checkpoint inhibitors

Figure 1The alternative text for this image may have been generated using AI.

Ophthalmologic findings in a representative case of VKH-like immune checkpoint inhibitor-associated uveitis (Case 1). A 71-year-old female was diagnosed with nasal malignant melanoma with multiple metastases at the age of 70 years. Following heavy particle radiation therapy, pembrolizumab treatment was initiated. Two months after starting immune checkpoint inhibitor (ICI) therapy, she developed grade 1 hyperthyroidism. Five months later, she visited an ophthalmologist due to a decline in visual acuity. Her visual acuity was Vd = (0.3) and Vs = (0.3). Multifocal exudative retinal detachment was observed in both fundi (a). Optical coherence tomography revealed an undulating bilateral retinal pigment epithelium, subretinal fluid, and diffuse choroidal thickening (b). Concurrently with ocular symptoms, she also reported hearing impairment. Cerebrospinal fluid examination revealed a cerebrospinal fluid cell count of 2/μL. On the basis of these findings, she was diagnosed with grade-3 ICI-associated VKH-like posterior uveitis. The ICI therapy was discontinued according to the ASCO guidelines (20). Bilateral betamethasone eye instillation, sub-Tenon’s capsule triamcinolone acetonide injection, and oral prednisolone at a dose of 30 mg were initiated. Following the initiation of ophthalmic treatment, improvement in retinal and choroidal findings was observed (c). Her visual acuity at the final visit was Vd = (0.9) and Vs = (0.8). Due to progression of the primary disease, she died 10 months after initiating ICI therapy.

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