Bilateral Harada-like reaction with bacillary layer detachment after treatment of metastatic signet ring cell carcinoma with pembrolizumab.

PURPOSE: To present a case of bilateral severe Harada-like reaction with bacillary layer detachments secondary to pembrolizumab therapy for metastatic signet ring cell carcinoma. METHODS: Case report. RESULTS: A 33-year-old black male with a medical history of aggressive metastatic signet ring cell carcinoma treated with Pembrolizumab developed a bilateral Harada-like reaction with bacillary layer detachment. The ocular disease improved after he was treated with high dose systemic corticosteroids and the pembrolizumab was discontinued. Local periocular steroid injections were given to treat the ocular inflammation and to facilitate systemic corticosteroid taper. A Harada-like reaction recurred after switching to nivolumab. CONCLUSION: Pembrolizumab can cause a Harada-like syndrome with bacillary layer detachment. Once the pembrolizumab is discontinued, and systemic and local corticosteroids are given, the ocular findings can resolve. Switching to a different checkpoint inhibitor may lead to a recurrence of ocular disease.

Duke Scholars

Author Glenn Jay Jaffe Ophthalmology, Vitreoretinal Diseases & Surgery