Atezolizumab induced immune-related adverse event mimicking conjunctival metastatic disease.

To describe a case of an immune-related adverse event associated with Atezolizumab therapy which was aggravated by ocular surgery. A 59-year-old man treated with Atezolizumab for metastatic non-small-cell lung cancer developed a conjunctival hypertrophic lesion mistaken for metastatic tissue. Biopsy surgery induced fulminant and multifocal granulomatous conjunctival tissue growth and sterile corneal ulceration. The immune-related adverse event was refractory to topical therapy, with curative success only after introduction of systemic prednisone. Atezolizumab use may be associated with severe and recalcitrant ocular surface inflammation with potential exacerbation after surgical interventions.

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© 2022 The Authors.

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The authors have no relevant financial, non-financial or proprietary interests to declare. A: Three hypertrophic, inflamed lesions in paralimbal conjunctival location with feeder vessel supply can be discriminated. The adjacent cornea is clear and inconspicuous. B: A homologous pseudomembranous lesion of the subtarsal inferior conjunctiva. A: Proper position of therapeutic contact lens, conjunctival auto-graft and conjunctival sutures. B: Decent position of the amnion patch graft and conjunctival sutures with low-grade inflammation. A: Pseudomembranous conjunctival regrowth at the paralimbal excision site with lost of auto-graft and avascular scleral tissue. B: Conjunctival pseudomembranous tissue at the auto-graft sampling location. C: Inferior sterile corneal ulceration without infiltration and lost of therapeutic contact lens.