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Ultrasound findings suggested an inflammatory aetiology and the patient was treated with an intravitreal dexamethasone implant. One month later, the lesion had regressed and visual acuity improved. Pembrolizumab, an immune checkpoint inhibitor, can cause ocular immune-related adverse effects, including choroidal inflammation. This case underscores the importance of distinguishing between inflammatory and metastatic lesions, particularly in patients with a history of ocular malignancy. Early recognition and appropriate treatment with steroids can prevent irreversible vision loss and multimodal imaging is crucial in such cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-265373","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:40:20Z","timestamp":1781872820000},"page":"e265373","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pembrolizumab-associated choroidal inflammation on a background of treated choroidal melanoma"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-459X","authenticated-orcid":false,"given":"Patrick","family":"Murtagh","sequence":"first","affiliation":[{"name":"Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro","family":"Gatchalian","sequence":"additional","affiliation":[{"name":"Royal Liverpool and Broadgreen Hospitals 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