Conjunctival reactive cutaneous capillary endothelial proliferation induced by camrelizumab in an esophageal cancer patient: a case report and literature review.

BACKGROUND: Camrelizumab-associated reactive cutaneous capillary endothelial proliferation (RCCEP) predominantly involves cutaneous surfaces. Mucosal involvement is exceptional, with no prior reports of conjunctival lesions. CASE PRESENTATION: A 64-year-old man with metastatic esophageal squamous cell carcinoma developed typical cutaneous RCCEP following initial camrelizumab exposure. Upon completion of three treatment cycles, he presented with bilateral conjunctival hyperemia, foreign body sensation, and purulent discharge. Slit-lamp examination revealed multiple vascular papules on the palpebral conjunctivae (Grade 3 RCCEP) with secondary bacterial infection. Unlike previously reported eyelid lesions requiring excision, conservative management with topical levofloxacin resulted in complete lesion resolution within four weeks without discontinuation of systemic therapy (Naranjo score: 7). CONCLUSION: This represents the first documented case of RCCEP affecting the conjunctival mucosa. It underscores the necessity of ophthalmologic surveillance in patients receiving camrelizumab and demonstrates that topical antimicrobial therapy constitutes an effective therapeutic strategy for complicated ocular RCCEP.