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Bilateral Diffuse Melanocytic Proliferation (BDUMP)

67 year old man
The patient started noticing dimming of the vision in November of 2020.  He had rapidly worsening cataracts. He had the cataract surgery done in both eyes in April of 2021.  The vision did not improve with the cataract surgery.  On June 1 of 2021 he had immunotherapy for his renal cell carcinoma and then developed severe vision loss.  The patient noticed that one of the commercials for nivolumab (checkpoint inhibitor targeting programmed death receptor-1) said it may cause vision loss.  He recalled that he started the nivolumab in October of 2020 and had vision loss starting then.    A retinal evaluation showed subretinal fluid and vision loss.   The peripheral vision and central vision were pretty good.  The vision did seem to get better off the nivolumab.  Then when the patient returned to Florida in September and now the vision is getting worse.  The patient did not have any treatments in either eye.  The patient is now off the oncology treatment.  He was then started on a TKI cabometex for the cancer which was dosed in mid June through mid July just for a month.  It was stopped because of a skin rash and reactions.  
VA OD: Dcc20/200-2 PHNI Ncc20/800
VA OS: Dcc20/63 PHNI NccJ7 He has been off the checkpoint inhibitor for a year.

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