Inflammatory keratitis and trastuzumab in the context of breast cancer - a case report

Abstract

Purpose: This case report aims to provide a comprehensive description of the presentation of a subepithelial inflammatory keratitis observed in a patient undergoing trastuzumab treatment. Study Design: Case report and review of the literature. Methods: To conduct a literature review, we used the ScienceDirect (Elsevier) and PubMed databases. Background: Trastuzumab is a molecule commonly employed in the treatment of breast cancer. It is principally known for its cardiotoxic adverse effects (1) (2); however, recent literature has started to shed light on potential ocular adverse effects associated with its use (2) (3) (4) (5) (6) (7) (8). Therefore, this case report details the experience of a female patient who underwent treatment with this molecule and subsequently developed an inflammatory keratitis. Case presentation: A 63-year-old female diagnosed with breast cancer, presented corneal haze, corneal edema, epithelial folds, and reduction of visual acuity following cataract surgery. A diagnosis of subepithelial inflammatory keratitis was established. A causal relationship was identified between the corneal inflammation and the trastuzumab, as evidenced by the amelioration of symptoms upon discontinuation of treatment. Diagnosis: Corneal haze was the first clinical sign of keratitis observed and it appeared approximately one month following cataract surgery. A Herpes simplex virus (HSV) keratitis was suspected and excluded after a negative polymerase chain reaction (PCR) and unsuccessful antiviral treatment. The keratitis was initially controlled with a topical 1% prednisolone acetate, but it recurred upon tapering. The patient eventually experienced a severe recurrence that did not respond to oral prednisone. This led to discontinuation of trastuzumab for several weeks, resulting in the resolution of inflammation even after tapering oral prednisone and topical 1% prednisolone. Conclusion: The antineoplastic agent trastuzumab carries notable ocular risks such as subepithelial inflammatory keratitis as evidenced by this case report and the literature.