Nivolumab-induced hypoalbuminemia causing serous retinal detachment

PURPOSE: To report a case of nivolumab induced hypoalbuminemia causing a serous retinal detachment. METHODS: Multimodal imaging including optical coherence tomography, fundus photography, and fluorescein angiography was performed. RESULTS: A 59-year-old female with a history of metastatic renal cell carcinoma on nivolumab/ipilimumab immunotherapy with a recent hospitalization for anasarca, ascites, pleural effusion, and hypotension developed bilateral chemosis and a serous retinal detachment in the right eye. There were no pachychoroid vessels, intraocular inflammation, or leakage on fluorescein angiography to suggest central serous chorioretinopathy or a Vogt-Koyanagi-Harada-like reaction to immunotherapy. The third spacing and hypoalbuminemia was thought to be due to nivolumab-induced capillary leak syndrome, and the offending medication was stopped. The conjunctival chemosis and subretinal fluid improved with correction of underlying systemic hypoalbuminemia. CONCLUSION: This case highlights a case of nivolumab-induced hypoalbuminemia causing a serous retinal detachment. This serves as an excellent teaching case as the authors discuss pertinent clinical exam and multimodal imaging features that allow differentiation of serous retinal detachments due to medications, central serous chorioretinopathy, and Vogt-Koyanagi-Harada syndrome.