Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event
A 67-year-old male with metastatic human papillomavirus (HPV)-positive oropharyngeal cancer receiving pembrolizumab (anti-programmed cell death protein 1 [PD-1] immune checkpoint inhibitor) presented with bilateral ocular dryness. It is important to note that these symptoms appeared eight months aft...
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MDPI AG
2025-05-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/15/9/1168 |
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| author | Hideki Fukuoka Akifumi Matsumoto Chie Sotozono |
| author_facet | Hideki Fukuoka Akifumi Matsumoto Chie Sotozono |
| author_sort | Hideki Fukuoka |
| collection | DOAJ |
| description | A 67-year-old male with metastatic human papillomavirus (HPV)-positive oropharyngeal cancer receiving pembrolizumab (anti-programmed cell death protein 1 [PD-1] immune checkpoint inhibitor) presented with bilateral ocular dryness. It is important to note that these symptoms appeared eight months after the initiation of the pembrolizumab therapy. Ophthalmologic evaluation revealed keratoconjunctivitis sicca with characteristic bulbar fluorescein staining and the Schirmer test showed 0 mm bilaterally. Serological testing demonstrated positive antinuclear and anti-SSb/La antibodies, consistent with Sjögren’s syndrome as an immune-related adverse event (irAE). Treatment with topical fluorometholone 0.1% and diquafosol 3% led to complete symptom resolution within one year while maintaining cancer immunotherapy. Long-term follow-up over 3.5 years demonstrated sustained ocular improvement and a favorable oncologic response without development of systemic autoimmune manifestations. This case highlights that Sjögren’s syndrome as an irAE may present with isolated ocular manifestations, which could be overlooked in clinical practice. |
| format | Article |
| id | doaj-art-3b04434072594e25be2d97f37d53ff4a |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-3b04434072594e25be2d97f37d53ff4a2025-08-20T02:59:14ZengMDPI AGDiagnostics2075-44182025-05-01159116810.3390/diagnostics15091168Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse EventHideki Fukuoka0Akifumi Matsumoto1Chie Sotozono2Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, JapanDepartment of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, JapanDepartment of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, JapanA 67-year-old male with metastatic human papillomavirus (HPV)-positive oropharyngeal cancer receiving pembrolizumab (anti-programmed cell death protein 1 [PD-1] immune checkpoint inhibitor) presented with bilateral ocular dryness. It is important to note that these symptoms appeared eight months after the initiation of the pembrolizumab therapy. Ophthalmologic evaluation revealed keratoconjunctivitis sicca with characteristic bulbar fluorescein staining and the Schirmer test showed 0 mm bilaterally. Serological testing demonstrated positive antinuclear and anti-SSb/La antibodies, consistent with Sjögren’s syndrome as an immune-related adverse event (irAE). Treatment with topical fluorometholone 0.1% and diquafosol 3% led to complete symptom resolution within one year while maintaining cancer immunotherapy. Long-term follow-up over 3.5 years demonstrated sustained ocular improvement and a favorable oncologic response without development of systemic autoimmune manifestations. This case highlights that Sjögren’s syndrome as an irAE may present with isolated ocular manifestations, which could be overlooked in clinical practice.https://www.mdpi.com/2075-4418/15/9/1168immune checkpoint inhibitorpembrolizumabSjögren’s syndromekeratoconjunctivitis siccaimmune-related adverse event (irAE)ocular toxicity |
| spellingShingle | Hideki Fukuoka Akifumi Matsumoto Chie Sotozono Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event Diagnostics immune checkpoint inhibitor pembrolizumab Sjögren’s syndrome keratoconjunctivitis sicca immune-related adverse event (irAE) ocular toxicity |
| title | Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event |
| title_full | Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event |
| title_fullStr | Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event |
| title_full_unstemmed | Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event |
| title_short | Immune Checkpoint Inhibitor-Related Sjögren’s Syndrome: An Ocular Immune-Related Adverse Event |
| title_sort | immune checkpoint inhibitor related sjogren s syndrome an ocular immune related adverse event |
| topic | immune checkpoint inhibitor pembrolizumab Sjögren’s syndrome keratoconjunctivitis sicca immune-related adverse event (irAE) ocular toxicity |
| url | https://www.mdpi.com/2075-4418/15/9/1168 |
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