Bilateral Panuveitis and Exudative Retinal Detachments Associated with Alpelisib

Abstract

We report a case of alpelisib-induced uveitis. A 68-year-old female who had recently been given alpelisib for metastatic breast cancer presented with a 2-week history of bilateral worsening vision with a corresponding acute hypermetropic shift. Her unaided visual acuity was 6/60 in both eyes, with bilateral anterior uveitis, non-granulomatous keratic precipitates, posterior synechiae, and limited fundal view. There was also a mild iris bombe configuration, although the intraocular pressures were normal. Ocular ultrasound revealed bilateral uveal effusion, ciliary body congestion, dense vitreous cells, and exudative retinal detachments. These findings were also confirmed on multimodal imaging with widefield fundus photography (Optos) and optical coherence tomography. Based on the clinical features above, a diagnosis of alpelisib-induced panuveitis was diagnosed. She was then admitted and treated with a 3-day course of intravenous methylprednisolone and intensive topical steroids. Her clinical signs and symptoms started to improve, and she was discharged 4 days later. At 1 week of follow-up, her best-corrected visual acuity was 6/12 in both eyes, with broken posterior synechiae and resolution of exudative retinal detachments. This case highlights the importance of early ophthalmology involvement by the oncology team as oncology therapy can have potential unexpected ocular manifestations.

Alirocumab-associated unilateral posterior uveitis

“…Drug-induced uveitis (DIU) is a rare but important form of uveitis, reported to have a prevalence of 0.5% in a tertiary uveitis referral centre 1. Early recognition and discontinuation of the offending drug can greatly improve the visual outcome and overall prognosis 2 3. Reports of DIU have increased in recent years, especially in association with novel immunotherapies and monoclonal antibodies, with onset varying from days to months 2 4 5…”

“…Early recognition and discontinuation of the offending drug can greatly improve the visual outcome and overall prognosis 2 3. Reports of DIU have increased in recent years, especially in association with novel immunotherapies and monoclonal antibodies, with onset varying from days to months 2 4 5…”