Summary Programmed cell death 1 (PD‐1) blockade has rapidly emerged as an effective therapy for a wide variety of metastatic malignancies. It has been associated with multiple immune‐related adverse effects, including cutaneous eruptions. We describe two patients with clinical and histological findings that were consistent with subacute cutaneous lupus erythematosus (SCLE) after receiving PD‐1 inhibitor therapy for metastatic lung cancer. We successfully treated our first patient with systemic and topical steroids, photoprotection and hydroxychloroquine. However, he subsequently developed dermatomyositis after continuing PD‐1 inhibitor therapy. Our second patient presented with a protracted course of a cutaneous eruption in spite of discontinuation of anti‐PD‐1 therapy and treatment with systemic corticosteroids and infliximab. This patient's SCLE resolved after the addition of topical steroids and photoprotection and discontinuation of anti‐tumour necrosis factor therapy. She and her oncology team decided to pursue non‐PD‐1 inhibitor treatment for lung cancer owing to a lack of tumour response. We add SCLE and dermatomyositis to the growing list of autoimmune complications of PD‐1 blockade. Our cases raise a number of questions, particularly in relation to the viability of continuing anti‐PD‐1 therapy after developing SCLE and the role of immunosuppressive therapy in patients with PD‐1 inhibitor‐associated connective tissue disease. What's already known about this topic? Programmed cell death 1 (PD‐1) blockade, which is rapidly emerging as a therapy for a wide variety of metastatic malignancies, has been associated with multiple immune‐related adverse effects. These include systemic autoimmune diseases such as colitis and thyroiditis in addition to numerous cutaneous adverse events. Cutaneous side‐effects of PD‐1 inhibitors most commonly reported in clinical trials include lichenoid reactions, eczematous dermatitis and vitiligo. What does this study add? We report two cases of PD‐1 inhibitor‐associated subacute cutaneous lupus erythematosus (SCLE), with one patient progressing to dermatomyositis with continued PD‐1 inhibitor treatment. In addition to being a novel cutaneous adverse event, we also demonstrate the possibility of development of multiple autoimmune diseases in one patient, which is different from classic drug‐related SCLE. We discuss the treatment challenges for patients with autoimmune skin disease receiving PD‐1 inhibitor therapy.
Background Autoimmune blistering disorders (AIBD) are rare, potentially life-threatening conditions often requiring immunosuppression. Throughout the SARS-CoV-2 pandemic, infection risk and mortality in AIBD patients is unknown. Objective We report outcomes of SARS-CoV-2 infections in AIBD patients and determined if patients on rituximab have increased risk of SARS-CoV-2 infection. Methods We examined clinical outcomes in ten AIBD patients who developed SARS-CoV-2 infections at an American hospital. We performed a retrospective analysis of 132 AIBD patients enrolled in a clinical trial. Results Patients with severe SARS-CoV-2 (n = 4) or death (n = 2) trended older. These patients had higher mortality than the national average (20% vs 1.6%). Our cohort included 52 patients with a history of rituximab treatment, 35 of whom were immunosuppressed by rituximab during the pandemic, and 45 patients never treated with rituximab. We found no difference between rates of SARS-CoV-2 positivity in AIBD patients immunosuppressed by rituximab compared to those not on rituximab (9.1% vs 12.1%). Limitations Testing for SARS-CoV-2 was performed on demand rather than surveillance. Overall transmission varied over time and outcomes depended on accepted treatments. The small sample size of our cohort limits the generalizability of our results. Conclusion This study suggests that rituximab may not increase the risk of SARS-CoV-2 test positivity in AIBD patients. However, these results should be interpreted with caution due to our relatively small sample size.
Novel oral anticoagulant (NOAC) medications have revolutionized hematology and cardiology. Recently, NOACs have demonstrated additional promise in dermatology. Specifically, rivaroxaban, a direct factor Xa inhibitor NOAC, has been shown to be successful in the treatment of livedoid vasculopathy. Herein, we describe a patient with systemic lupus erythematosus who presented with painful cutaneous vasculopathy, demonstrated on biopsy with occlusive microvascular fibrin thrombi without evidence of concurrent vasculitis. Interestingly, imaging and laboratory studies did not show evidence of hypercoagulability, arterial disease, or embolic disease. The patient's vasculopathy and pain progressed despite antiplatelet therapy, often considered first-line in cases of microvascular occlusive disease. However, with rivaroxaban therapy, the patient experienced complete regression of her painful lesions, thereby supporting a further role for NOACs in cutaneous vasculopathy treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.