一名接受免疫检查点抑制剂治疗的恶性粘膜黑色素瘤患者因脉络膜炎和炎症性脉络膜新生血管膜而显示结核病再激活

Melissa L. Murphy, Duncan Rogers
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引用次数: 0

摘要

描述一例在接受免疫检查点抑制剂(ICPI)治疗恶性粘膜黑色素瘤后,眼部结核再活化并伴有前葡萄膜炎、脉络膜炎和炎性脉络膜新生血管膜(CNVM)的复杂病例。我们对病史、临床发现和多模态成像进行了回顾性收集,并对相关文献进行了综述。一名 52 岁的罗马尼亚女性在接受了由伊匹单抗和尼沃单抗组成的三个周期的 ICPI 治疗后,出现了视力下降和畏光症状。通过裂隙灯检查和辅助多模态成像确认了双侧前葡萄膜炎、左眼多个脉络膜病变和一个CNVM。右眼视网膜病变、曾接受过治疗的后葡萄膜炎病史和高危种族背景增加了临床对眼部结核病(TB)再活化的怀疑。肺部吸出物聚合酶链式反应(PCR)分析显示结核菌阳性,经全身抗结核治疗(ATT)、全身类固醇治疗和抗血管内皮生长因子(VEGF)治疗后临床症状明显好转,最终确诊。ICPIs 可通过原发性免疫调节作用和继发性潜伏疾病再激活引起各种眼部问题。
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Tuberculosis reactivation demonstrated by choroiditis and inflammatory choroidal neovascular membrane in a patient treated with immune checkpoint inhibitors for malignant mucosal melanoma
To describe a complex case of ocular tuberculosis reactivation with anterior uveitis, choroiditis and inflammatory choroidal neovascular membrane (CNVM) following immune checkpoint inhibitor (ICPI) treatment of malignant mucosal melanoma. A retrospective collection of medical history, clinical findings and multimodal imaging with literature review of the topic was conducted. A 52-year-old Romanian female developed reduced vision and photophobia after three cycles of ICPI therapy comprised of ipilimumab and nivolumab. Bilateral anterior uveitis, multiple left eye choroidal lesions and a CNVM were confirmed using slit-lamp examination with ancillary multimodal imaging. Retinal changes in the right eye as well as a history of previously treated posterior uveitis and high-risk ethnicity increased clinical suspicion for ocular tuberculosis (TB) reactivation. The diagnosis was confirmed by TB positivity on polymerase chain reaction (PCR) analysis of lung aspirate followed by significant clinical improvement on systemic anti-tubercular therapy (ATT), systemic steroids and anti-vascular endothelial growth factor (VEGF) therapy. ICPIs can cause a myriad of ocular issues, both by primary immunomodulatory effects as well as secondary reactivation of latent disease.
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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
期刊最新文献
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