A case of melanoma-associated retinopathy with autoantibodies against TRPM1
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CLINICAL CASE REPORT
A case of melanoma-associated retinopathy with autoantibodies against TRPM1 Min Seok Kim . Hye Kyoung Hong . You Jin Ko . Kyu Hyung Park . Shinji Ueno . Satoshi Okado . Se Joon Woo . Kwangsic Joo
Received: 18 February 2020 / Accepted: 13 May 2020 Ó Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To report a case of melanoma-associated retinopathy (MAR) with autoantibodies against the transient receptor potential cation channel, subfamily M, member 1 (TRPM1) with asymmetric severe vision loss. Methods We evaluated a patient with heel skin melanoma showing progressive vision loss in both eyes confirmed with a baseline ophthalmic examination, fluorescein angiography, spectral domain optical coherence tomography (OCT), visual field test, and full-field electroretinogram (ERG). Immunofluorescence assays and western blot analysis revealed autoantibodies in the patient’s serum. Results The patient’s best-corrected visual acuities were 20/50 in the right eye and hand motion in the left eye. Visual field test showed severely depressed visual fields especially in the left eye. Fluorescein angiography and OCT revealed extrafoveal choroidal neovascularization in the left eye. The patient had an
M. S. Kim H. K. Hong Y. J. Ko K. H. Park S. J. Woo K. Joo (&) Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea e-mail: [email protected] S. Ueno S. Okado Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
electronegative ERG, suggesting MAR, and autoantibodies against TRPM1 and aldolase C were detected in the patient’s blood sample. Conclusions The clinical features of MAR patients with positive anti-TRPM1 autoantibodies can be manifested as severe vision loss, and the identification of autoantibodies can be helpful for confirming the diagnosis. Keywords Aldolase C Antiretinal autoantibody Melanoma-associated retinopathy TRPM1
Introduction Melanoma-associated retinopathy (MAR) is a subclass of autoimmune retinopathy occurring in patients with cutaneous melanoma, typically months to years after the initial diagnosis of melanoma [1]. Melanoma cells express multiple antigens that may activate the immune system to produce circulating autoantibodies. These autoantibodies target certain retinal cells and cause retinal pathology [2]. Transient receptor potential cation channel, subfamily M, member 1 (TRPM1), an mGluR6-coupled ion channel in the retinal ON bipolar cell signal transduction pathway, has been reported as one of the target antigens for MAR [3]. A characteristic electroretinographic waveform (normal a-wave and reduction in the b-wave amplitude) which
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Doc Ophthalmol
A 58-year-old man with a recent medical history of cutaneous malignant melanoma in his left heel was referred to our ophthalmology department with symptoms of decre
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