Stage IV small-cell lung cancer with hepatic metastases: serplulimab stopped after VKH-like uveitis

What happened, in summary

This 70-year-old Chinese man was diagnosed on 11 December 2023 with small-cell lung carcinoma that had spread to the liver. He received serplulimab, an anti-PD-1 immunotherapy, at 300 mg every 3 weeks for 4 cycles. About 5 days before eye evaluation, he developed mild bilateral blurred vision. His best-corrected visual acuity was 0.15 in the right eye and 0.25 in the left eye. Eye examination showed anterior-chamber cells, dense vitreous opacities, and focal serous retinal detachment. Fluorescein angiography showed pinpoint leakage and late optic-disc hyperfluorescence, while optical coherence tomography showed bilateral serous retinal detachment, choroidal thickening, and wavy changes of the retinal pigment epithelium. Because choroidal metastasis can mimic this presentation, his team evaluated for ocular spread of cancer. Cerebral MRI, retinal angiography, and cerebrospinal fluid testing helped rule out inflammatory or metastatic neuropathies and supported a diagnosis of serplulimab-related VKH-like uveitis. Serplulimab was discontinued. He began oral prednisone 40 mg daily, but initially refused intravenous corticosteroids. After 3 days, subretinal fluid decreased but vision had not yet improved. After 1 month of oral prednisone, best-corrected visual acuity improved to 0.6 in the right eye and 0.4 in the left eye. The cancer-response outcome after stopping serplulimab was not detailed. His record is best understood as Stage IV SCLC complicated by a serious immune-related eye toxicity requiring immunotherapy discontinuation and steroid treatment. Follow-up after serplulimab was stopped centered on the eye complication rather than a detailed cancer-response assessment. The patient-facing outcome is ongoing care after treatment interruption, with the eye complication and partial visual recovery clearly described.