Open AccessA Case of Nivolumab-Induced Cutaneous Toxicity with Multiple Morphologies
Author(s) -
Nguyen Emily D.,
Xue Yun K.,
Danesh Melissa,
Ameri Amir,
Weng Christina Q.,
Klebanov Nikolai,
Foreman Ruth K.,
Nazarian Rosalynn M.,
Demehri Shadmehr,
Tsao Hensin,
Kroshinsky Daniela
Publication year - 2020
Publication title -
dermatopathology
Language(s) - English
Resource type - Journals
ISSN - 2296-3529
DOI - 10.1159/000505353
Subject(s) - clinico pathological correlation in dermatopathology
Cutaneous reactions are among the most prevalent immune-related adverse events in patients treated with immunotherapy. Given that immunotherapies often act through blocking inhibitory signals on T cells, these treatments also have the potential to generate a host of immune toxicities. We report the case of a 73-year-old woman with a history of non-small cell lung cancer treated with nivolumab 10 months prior to presentation who developed painful nodules, bullae, and a scaly rash on her extremities. Four months after discontinuation of nivolumab, she noted an acute eruption of painful nodules on her extremities, followed by pink papules and tense bullae on her palms and soles. Biopsies were performed of three lesions in sites of varying morphologies. These findings were felt to be consistent with a nivolumab-induced lichenoid reaction. She was initially treated with intralesional steroid injections, topical steroid ointment, and liquid nitrogen cryotherapy with minimal improvement. As the lesions continued to progress, the patient was admitted to the hospital and started on intravenous methylprednisolone. She eventually transitioned to daily oral prednisone with a slow taper with good effect and no recurrence of lesions.