VKH-like syndrome in the setting of Dabrafenib and Trametinib therapy for BRAF mutant metastatic melanoma: A case report

Abstract

Abstract Background: To report a unique case of Vogt‒Koyanagi‒Harada (VKH)-like uveitis in a patient with BRAF mutant metastatic melanoma associated with concurrent use of BRAF and MEK inhibitors. Case presentation: A 49-year-old woman with stage IV metastatic cutaneous melanoma developed bilateral acute pan-uveitis with multifocal serous retinal detachments, four months after starting combined dabrafenib and trametinib therapy. Clinical assessment, together with fluorescein angiography, optical coherence tomography, and serology, to exclude other key differential diagnoses led to the diagnosis of VKH-like uveitis. Prompt systemic corticosteroids and modification of the dosing schedule of the suspected offending agents resulted in the resolution of intraocular inflammation and serous retinal detachments. Currently, systematic reviews reporting ocular adverse effects of combined dabrafenib and trametinib therapy are limited, although a retrospective study by Mettler et al. reported an odds ratio of 21.8 for VKH-like disease. Management of VKH in reported cases involves discontinuation of offending agents and initiation of intravenous corticosteroids for three days, followed by tapering oral corticosteroid treatment. Conclusion: Both ophthalmologists and oncologists should be aware of the potential association between VKH-like uveitis and BRAF and MEK inhibitors, as these medications are becoming more common in the management of metastatic malignancies. Early and prompt recognition of this condition and treatment can be sight saving without compromising treatment for metastatic malignancy.