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Development of Acute Vogt-Koyanagi-Harada-like Syndrome during the Treatment Course with Vemurafenib for Metastatic Melanoma.

在Vemurafenib治疗转移性黑色素瘤的过程中发生急性Vogt-小柳-原田样综合征。

  • 影响因子:1.52
  • DOI:10.1080/09273948.2019.1597896
  • 作者列表:"Apivatthakakul A","Kunavisarut P","Rothova A","Pathanapitoon K
  • 发表时间:2020-04-02
Abstract

:Purpose: To report on ocular Vogt-Koyanagi-Harada (VKH)-like syndrome under vemurafenib treatment for metastatic melanoma.Design: A case report.Method: Description of clinical and imaging manifestations including fundus photography, fluorescein, and indocyanine green angiography.Results: A 46-year-old Thai female was diagnosed with metastatic melanoma of the skin and had been treated with multiple surgical excisions, radiotherapy, and vemurafenib (initial dose 480 mg orally twice daily, subsequently increased to maximum dose of 960 mg twice daily). After 6 months of vemurafenib use, she complained of bilateral redness and photophobia and was diagnosed with bilateral anterior uveitis, which was topically treated. Two weeks later, her visual acuity (VA) sharply deteriorated to 20/80 and counting fingers. Ocular examination at that stage stronly resembled acute VKH disease. She exhibited intraocular inflammation, and her fundus examination revealed bilateral optic disc swelling and serous retinal detachment. Fluorescein angiogram showed disc leakage and multiple pinpoint hyperfluorescence leakage spots and indocyanine green demonstrated multiple hypofluorescent spots. Oral prednisolone 30 mg/day was commenced while vemurafenib medication was ceased. Three weeks later, her vision improved, and serous retinal detachment subsided. However, her cutaneous melanoma recurred.Conclusions: Vemurafenib, a potential adjunct treatment for metastatic melanoma, was complicated by the development of panuveitis, papillitis, and multiple serous detachments. These ocular symptoms were similar to the presentation of acute VKH syndrome.

摘要

目的: 报道vemurafenib治疗转移性黑色素瘤下的眼部Vogt-小柳原田 (VKH) 样综合征。设计: 病例报告。方法: 描述临床和影像学表现,包括眼底照相、荧光素和吲哚青绿血管造影。结果: 一名 46 岁的泰国女性被诊断为皮肤转移性黑色素瘤,并接受了多次手术切除,放射治疗和vemurafenib (初始剂量 480 mg口服,每日两次,随后增加至最大剂量 960 mg,每日两次)。使用vemurafenib 6 个月后,主诉双侧发红、畏光,诊断为双侧前葡萄膜炎,予以局部治疗。两周后,她的视力 (VA) 急剧恶化至 20/80,并计数手指。该阶段的眼部检查stronly类似于急性VKH病。她表现出眼内炎症,眼底检查发现双侧视盘肿胀和浆液性视网膜脱离。荧光素血管造影显示椎间盘渗漏和多个精确的超荧光渗漏点,吲哚青绿显示多个低荧光点。开始口服泼尼松龙 30 mg/天,同时停止vemurafenib药物治疗。三周后,她的视力改善,浆液性视网膜脱离消退。然而,她的皮肤黑色素瘤复发。结论: Vemurafenib是转移性黑色素瘤的潜在辅助治疗药物,并发全葡萄膜炎、乳头炎和多发性浆液性脱离。这些眼部症状与急性VKH综合征的表现相似。

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皮肤肿瘤方向

皮肤肿瘤是发生在皮肤的细胞增生性疾病,是一种常见病。发生于皮内或皮下组织的新生物,种类很多,临床上分良性肿瘤和恶性肿瘤。恶性肿瘤可以不断增殖,引起转移,威胁生命,称为皮肤癌。

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