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JAMA Clinical Challenge
August 22, 2019

Rapidly Progressive Vision Loss in a Patient With Breast Cancer

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Department of Medicine, Reading Hospital and Medical Center, West Reading, Pennsylvania
  • 3Berks Eye Physicians & Surgeons Ltd, Reading, Pennsylvania
JAMA. 2019;322(11):1098-1099. doi:10.1001/jama.2019.12691

A 67-year-old white female patient with metastatic breast cancer, currently taking capecitabine plus trastuzumab, presented with 2 weeks of painless reduced vision in her right eye (OD). Her breast cancer was diagnosed in 2007 as stage IA estrogen-receptor positive, progesterone-receptor negative (ER+, PR−), and human epidermal growth factor 2 (ERBB2; formerly HER2) negative, initially treated with lumpectomy plus left breast radiotherapy followed by doxorubicin, cyclophosphamide, paclitaxel, and anastrazole. In 2017, metastases were found in the lumbar spine and lung and treated with fulvestrant and palbociclib plus left brachial plexus radiotherapy. Later, progressive liver metastasis and repeat biopsy with equivocal ERBB2 testing led to treatment with capecitabine plus trastuzumab.