Immune checkpoint inhibitor-associated uveitis in metastatic melanoma: case report and literature review

Immune checkpoint inhibitors (ICIs), including programmed cell death-1 inhibitors such as nivolumab and cytotoxic T-lymphocyte-associated antigen-4 inhibitors such as ipilimumab, have become a cornerstone in the management of advanced melanoma, significantly improving survival outcomes. However, their use is increasingly associated with immune-related adverse events, including ocular inflammation. Although uncommon, ICI-associated uveitis represents a potentially sight-threatening complication with variable clinical presentation. We present a case of bilateral granulomatous panuveitis in a 56-year-old female receiving combined nivolumab and ipilimumab therapy for metastatic melanoma of unknown primary origin, together with a review of the literature. Ocular symptoms developed approximately 2.5 months after treatment initiation. Clinical examination revealed bilateral anterior chamber inflammation with granulomatous keratic precipitates, posterior synechiae, and vitritis accompanied by choroidal undulations. Infectious, systemic autoimmune etiologies and metastatic ocular involvement, were excluded. The clinical severity was consistent with the Common Terminology Criteria for Adverse Events grade 3 uveitis, necessitating systemic and pulsed corticosteroid therapy and discontinuation of immunotherapy. In melanoma patients receiving ICIs, uveitis most commonly presents as anterior uveitis but may also involve the posterior segment or manifest as panuveitis, including Vogt-Koyanagi-Harada-like phenotypes. Most cases occur within the first few months of treatment. Management is guided by disease severity, ranging from topical to systemic corticosteroids, with consideration of immunotherapy interruption. This case highlights the heterogeneous clinical spectrum of ICI-associated uveitis in melanoma and underscores the importance of early diagnosis and multidisciplinary management. Close collaboration between ophthalmologists and oncologists is essential to optimize both visual outcomes and melanoma treatment strategies.