Anterior Uveitis Secondary to Avelumab and Pembrolizumab in a Patient with Metastatic Renal Cell Carcinoma-A Case Report

We present an unusual case of uveitis secondary to avelumab and pembrolizumab in a 39-year-old Taiwanese male with stage IV clear cell renal cell carcinoma (ccRCC) and lung metastasis, who initially received pembrolizumab as his primary treatment. However, the patient experienced skin and liver immune-related adverse events (irAEs) after the seventh dose of pembrolizumab, which prompted a switch to avelumab. The patient began to experience gradual blurring of vision after completing the fifth cycle of avelumab immunotherapy. Ophthalmic examinations revealed findings consistent with bilateral anterior uveitis. Despite an initial lack of significant improvement with steroid treatment, the patient's vision and inflammation improved upon discontinuation of avelumab. Due to the occurrence of uveitis, avelumab was switched back to pembrolizumab. However, three months after initiating pembrolizumab, the patient developed foggy vision and bilateral anterior uveitis with cystoid macular edema (CME). The administration of topical, oral, and subconjunctival steroids resulted in an improvement in vision and the resolution of CME, without the need to discontinue pembrolizumab. Over the subsequent eighteen months, there has been no recurrence of uveitis, and there is no evidence of relapse or further metastasis in his ccRCC.