Refractory Bullous Pemphigoid in a Patient with Metastatic Lung Adenocarcinoma Treated with Pembrolizumab

Case Reports in Oncology

卷:14

Santiago Ariza¹  Alejandro Ruiz-Patiño²  Andrés F. Cardona²  Luisa Ricaurte³  Oscar Arrieta⁴  Zyanya Lucia Zatarain-Barron⁴  Christian Rolfo⁵ 

[1] Dermatology Oncology Department, Clínica Colsanitas, Bogotá, Colombia;

[2] Oncology Department, Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia;

[3] Pathology Department, Mayo Clinic, Rochester, MN, USA;

[4] Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico;

[5] Thoracic Oncology Unit, Marlene and Stewart Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA;

关键词: immunotherapy;    pembrolizumab;    adverse events;    toxicity;    skin reactions;   

DOI  :  10.1159/000514144

来源: DOAJ

【 摘 要 】

We present the case of a 73-year-old male patient with a history of tobacco use who presented with a central nervous system mass that was confirmed to be a lung adenocarcinoma metastasis. High PD-L1 expression as well as negativity to other targetable drivers led to initiation of pembrolizumab monotherapy and ablative stereotactic radiation therapy on oligo­residual disease, achieving a complete response after 2 years of therapy. Following discontinuation of systemic treatment, the patient developed widespread desquamative plaques. A skin biopsy revealed subepidermal blistering and eosinophilic infiltration in conjunction with C3 and IgG depositions on the basement membrane, detected by immunofluorescence. A diagnosis of bullous pemphigoid was obtained, and systemic corticosteroids were administered with lesion progression. Infliximab was also administered without meaningful clinical improvement. Metronomic cyclophosphamide achieved a complete resolution of skin lesions and up to this day the patient continues with tumor control and is free of dermatological findings. In conclusion, bullous pemphigoid is a very rare dermatological adverse effect related with pembrolizumab treatment. Only two cases, including this one, have been reported, especially with this medication for the treatment of non-small cell lung cancer. With more reported cases, management strategies can be optimized even in the steroid refractory setting.

【 授权许可】

Unknown