Ribociclib Response in Impending Visceral Crisis Accompanied by Choroidal Metastasis

Choroidal metastases represent a rare manifestation of metastatic breast cancer, occurring in approximately 2–7% of cases, and typically indicate advanced systemic disease with poor prognosis.We report a 49-year-old premenopausal woman with hormone receptor–positive, HER2-negative metastatic breast carcinoma involving the pleura and bones. She presented with progressive dyspnea, back pain, and blurred vision in the right eye. Imaging revealed a large malignant pleural effusion, extensive osteolytic lesions, and a left breast mass with axillary lymphadenopathy. Ophthalmologic evaluation confirmed a right choroidal metastasis.Given her worsening respiratory function and recurrent pleural effusion despite drainage, the clinical picture was consistent with an impending visceral crisis. Systemic treatment with ovarian suppression, letrozole, ribociclib, and denosumab was promptly initiated.Follow-up revealed marked systemic improvement and complete resolution of visual symptoms. This case underscores the importance of rapid ophthalmologic assessment in patients with breast cancer with visual complaints. It highlights that timely systemic therapy may induce regression of choroidal lesions and prevent progression to overt visceral crisis.