Immune checkpoint inhibitor-associated uveitis in a patient with breast cancer and a remote history of Vogt–Koyanagi–Harada disease: a case report

Abstract Immune checkpoint inhibitors (ICIs) have demonstrated substantial efficacy in the treatment of triple-negative breast cancer (TNBC). However, appropriate management of immune-related adverse events (irAEs) remains essential, and patients with a history of autoimmune disease have an increased risk of developing irAEs. Immune-related uveitis represents an uncommon irAE overall and has been reported most frequently in melanoma, whereas reports among patients with BC remain rare. We describe a case of ICI-associated uveitis occurring shortly after treatment initiation in a patient with a very remote history of autoimmune uveitis. A woman in her 50s with locally advanced TNBC (cT4bN0M0, stage IIIB) and a history of Vogt–Koyanagi–Harada disease–associated uveitis in complete remission for more than 25 years received neoadjuvant chemotherapy combined with pembrolizumab. Three weeks after initiation, decreased visual acuity developed in the left eye, and grade 2 uveitis was diagnosed as an irAE. Pembrolizumab was discontinued, and systemic corticosteroid therapy was initiated, resulting in early ophthalmic improvement. Subsequently, Stevens–Johnson syndrome developed after prophylactic trimethoprim–sulfamethoxazole administration, necessitating steroid pulse therapy and high-dose intravenous immunoglobulin, after which the uveitis completely resolved. Neoadjuvant chemotherapy was continued without pembrolizumab, followed by mastectomy, which revealed ypT1aN0 disease. At 2 years of follow-up, the patient remains disease-free without recurrence of uveitis. This case indicates that a remote history of autoimmune uveitis may represent a risk factor for ICI-associated uveitis, supporting the need for careful pretreatment assessment, vigilant monitoring, and close collaboration with ophthalmologists.