Bilateral Exudative Retinal Detachment Associated with Denosumab Therapy: Case Report

초록

Purpose: To report a case of bilateral exudative retinal detachment (ERD) that developed in temporal association with denosumab therapy and resolved after denosumab discontinuation, with no recurrence during approximately 19 months of follow-up despite continued systemic anticancer therapy. Case summary: A 70-year-old woman with HER2-positive breast cancer and a history of bone metastasis had received denosumab 120 mg every four weeks for approximately 34 months (38 injections; cumulative dose, 4,560 mg) while receiving ongoing trastuzumab deruxtecan. She was diagnosed with denosumab-related osteonecrosis of the jaw and noticed bilateral visual decline around the same period. At presentation, best-corrected visual acuity (BCVA) was 0.4 in both eyes, and optical coherence tomography revealed bilateral ERD involving the posterior pole. No ERD-directed ophthalmic or systemic anti-inflammatory treatment was initiated; routine intravenous dexamethasone premedication before trastuzumab deruxtecan was continued unchanged. The ERD and subretinal fluid resolved completely within two months, and BCVA improved to 0.9 in both eyes by six months. Denosumab was not resumed, whereas trastuzumab deruxtecan was continued. No recurrence was observed during approximately 19 months of follow-up through July 2026. Conclusions: This case suggests a possible association between denosumab therapy and bilateral ERD. Although causality cannot be established from a single case, the prolonged cumulative exposure, temporal relationship, concomitant denosumab-related osteonecrosis of the jaw, resolution after discontinuation, and absence of recurrence despite continued trastuzumab deruxtecan support consideration of denosumab as a potential medication-related factor in otherwise unexplained ERD.

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