면역항암치료제(Pembrolizumab) 관련 보크트-고야나기-하라다 유사 증후군 1예
A Case of Vogt-Koyanagi-Harada-like Syndrome Associated with Immunotherapy (Pembrolizumab)
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목적: 비소세포폐암 환자에서 면역요법(펨브로리주맙)을 사용한 후 발생한 보크트-고야나가-하라다 유사 증후군 1예를 보고하고자한다. 증례요약: 64세 여자가 양안의 시력저하를 주소로 내원하였다. 환자는 비소세포폐암으로 호흡기내과에서 면역항암제(펨브로리주맙) 를 사용하고 있었다. 안저검사와 빛간섭단층촬영에서 양안에 다발성 망막내액 및 망막하액이 나타났다. 양안 모두 보크트-고야나기- 하라다병 진단 하에 형광안저혈관조영술 및 인도시아닌그린혈관조영술 후 2주간 경구용 프레드니솔론 40 mg/day로 사용하였다. 2주후 외래 내원 시 증상이 호전되었고 안저검사 및 빛간섭단층촬영에서 다발성 망막내액 및 망막하액의 감소를 보였다. 이후 경구용프레드니솔론을 20 mg/day 2주로 줄였다. 2주 후 외래 내원 시 증상이 호전되었고 안저검사 및 빛간섭단층촬영에서 다발성 망막내액과 망막하액이 소실되었으며 우안 황반 부근에 소량의 망막하액만 남아 있었다. 결론: 펨브로리주맙 사용 후 발생할 수 있는 보그트-고야나기-하라다병은 빠르게 진단하여 경구용 프레드니솔론으로 치료할 수 있다.
Abstract
Purpose: To report a case of Vogt-Koyanagi-Harada-like syndrome that occurred during immunotherapy (pembrolizumab) in a patient with non-small-cell lung cancer (NSCLC). Case summary: A 64-year-old female visited our clinic complaining of decreased visual acuity in both eyes. The patient had NSCLC and had been prescribed immunotherapy (pembrolizumab) by the Department of Pulmonology. Fundus examination and optical coherence tomography revealed multiple intraretinal cysts and subretinal fluid in both eyes. After evaluation using fluorescein and indocyanine green angiography, Vogt-Koyanagi-Harada (VKH) disease was diagnosed in both eyes and oral prednisolone 40 mg/day was prescribed for 2 weeks. At an outpatient visit at that time, the symptoms had improved, and fundus examination and optical coherence tomography revealed decreases in the number of intraretinal cysts and the subretinal fluid level. Oral prednisolone was reduced to 20 mg/day for 2 weeks. At an outpatient visit at that time, the symptoms had further improved; no cysts or subretinal fluid were apparent on fundus examination or optical coherence tomography, and only a small amount of subretinal fluid was present near the macula of the right eye. Conclusions: VKH disease may develop during immunotherapy (pembrolizumab) but can be rapidly diagnosed and treated with oral steroids.
참고문헌 (14)
- Gangadhar TC, "Clinical applications of PD-1-based therapy : a focus on pembrolizumab(MK-3475)in the management of melanoma and other tumor types", Onco Targets Ther, 8, pp.929~937 (2015)
- Reck M, "Pembrolizumab versus chemotherapy for PD-L1-positive nonsmall-cell lung cancer", N Engl J Med, 375, pp.1823~1833 (2016)
- Ushio R, "Nivolumab-induced Vogt-Koyanagi-Harada-like syndrome and adrenocortical insufficiency with long-term survival in a patient with non-small-cell lung cancer", Intern Med, 60, pp.3593~3598 (2021)
- Bricout M, "Vogt-Koyanagi-Harada-like syndrome complicating pembrolizumab treatment for metastatic melanoma", J Immunother, 40, pp.77~82 (2017)
- Abdel-Rahman O, "Immune-related ocular toxicities in solid tumor patients treated with immune checkpoint inhibitors : a systematic review", Expert Rev Anticancer Ther, 17, pp.387~394 (2017)
- Crosson JN, "Vogt-Koyanagi-Harada-like syndrome after CTLA-4 inhibition with ipilimumab for metastatic melanoma", J Immunother, 38, pp.80~84 (2015)
- Kikuchi R, "Vogt-Koyanagi-Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy : a case report", BMC Ophthalmol, 20, pp.252~ (2020)
- Tamura T, "Vogt-Koyanagi-Harada syndrome induced by pembrolizumab in a patient with non-small cell lung cancer", J Thorac Oncol, 13, pp.1606~1607 (2018)
- Telfah M, "Vision loss with pembrolizumab treatment : a report of two cases", J Oncol Pharm Pract, 25, pp.1540~1546 (2019)
- Antoun J, "Ocular and orbital side-effects of checkpoint inhibitors : a review article", Curr Opin Oncol, 28, pp.288~294 (2016)
- Dalvin LA, "Checkpoint inhibitor immune therapy : systemic indications and ophthalmic side effects", Retina, 38, pp.1063~1078 (2018)
- Wong RK, "Bilateral drug(ipilimumab)-induced vitritis, choroiditis, and serous retinal detachments suggestive of Vogt-Koyanagi-Harada syndrome", Retin Cases Brief Rep, 6, pp.423~426 (2012)
- Kurono Y, "Vogt-Koyanagi-Harada disease during chemoimmunotherapy for non-small cell lung cancer", Respirol Case Rep, 8, pp.e00545~ (2020)
- Beniz J, "Variations in clinical features of the Vogt-Koyanagi-Harada syndrome", Retina, 11, pp.275~280 (1991)