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irAEs: immune-related adverse events TEN: toxic epidermal necrolysis PD-1: programmed death-1 protein INTRODUCTION The programmed death-1 protein (PD-1) pathway is an inhibitory mechanism exploited by tumors to evade destruction by the host immune system. Immunogenic cancers such as lymphoma and melanoma overexpress the PD-1 receptor ligand (PD-L1), which selectively inhibits the host T-cellemediated antitumor response. Nivolumab, a humanized IgG4 antiePD-1 antibody, stimulates the native T-cell response by inhibiting PD-1 receptor ligand binding to T cells, leading to impressive tumor control. This action is nonspecific, and immune-related adverse events (irAEs) are well described after checkpoint inhibition. Life-threatening immune-related skin toxicity is uncommon. We report a case of fatal toxic epidermal necrolysis (TEN) secondary to nivolumab in lymphoma to highlight the challenges of managing this rare complication.

Toxic epidermal necrolysis (TEN) associated with the use of nivolumab (PD-1 inhibitor) for lymphoma