A Case of Bilateral Multifocal Choroiditis Associated with BRAF/MEK Inhibitor Use for Metastatic Cutaneous Melanoma

ABSTRACT

Purpose

To report a case of BRAF/MEK inhibitor-associated multifocal choroiditis that recurred after medication re-exposure and resolved after discontinuing BRAF/MEK inhibition and administering local steroid therapy.

Case Report

A 32-year-old woman with metastatic cutaneous melanoma on dabrafenib/trametinib presented with bilateral anterior uveitis and new bilateral multifocal chorioretinal scars. The anterior uveitis resolved after a course of topical steroids. She presented 18 months later with reactivation of bilateral multifocal choroiditis after starting encorafenib/binimetinib 1 month prior. The chorioretinal lesions appeared elevated with associated vitreous cell. Indocyanine angiography showed numerous foci of new choroiditis, more pronounced in the left eye. Encorafenib/binimetinib was discontinued and a subtenon triamcinolone injection was administered to the left eye. Her symptoms improved and the choroiditis resolved.

Conclusion

BRAF/MEK inhibitors may be associated with ocular toxicity manifesting as multifocal choroiditis. The increasing use of these agents and risk of visual impairment warrants early detection and management.

KEYWORDS:

• MEK retinopathy
• dabrafenib and trametinib
• encorafenib and binimetinib
• uveitis
• multifocal choroiditis
• metastatic melanoma
• drug-induced uveitis

Patient consent

Consent to publish the case report was not obtained. This report does not contain any personal information that could lead to the identification of the patient. Our institution does not require consents to be obtained for single case reports.

Acknowledgments

The authors would like to gratefully acknowledge John Stivers for his consistent efforts to achieve the highest standards in ophthalmic photography, which make advanced patient care and reports like this possible.

Authorship

All authors attest that they meet the current ICMJE criteria for Authorship.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.