Choroidal Leakage during Daratumumab Therapy: A Desensitization-Based Strategy for Treatment Continuation in Relapsed/Refractory Multiple Myeloma.

BACKGROUND: Daratumumab is widely used in relapsed/refractory multiple myeloma, but ocular adverse events are rare and not well-characterized. CASE PRESENTATION: A 68-year-old woman developed acute blurred vision during the second day of her first daratumumab infusion. Multimodal imaging, including fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT), demonstrated bilateral choroidal leakage with subretinal fluid and choroidal vascular changes. MANAGEMENT AND OUTCOME: Daratumumab was temporarily discontinued due to suspected drug-related ocular toxicity. Following complete symptom resolution, treatment was successfully reintroduced using a 12-step desensitization protocol with close monitoring. No recurrence of ocular symptoms was observed, and follow-up imaging showed regression of subretinal fluid. CONCLUSION: This case highlights a rare ocular complication associated with daratumumab and suggests that desensitization may enable safe continuation of therapy in selected patients with non-vision-threatening findings. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.