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

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.