Bullous pemphigoid induced by nivolumab in a patient with malignant melanoma

Abstract

Immune checkpoint inhibitors, such as nivolumab, have been recognized that the enhanced immune responses often lead to immune-related adverse events (irAEs) in various organs. Although cutaneous toxicity is one of the most common irAEs, bullous pemphigoid (BP) with immune checkpoint inhibitors is rare. Herein, the authors report a case of BP in a patient of the metastatic malignant melanoma of the brain under the treatment of nivolumab. It is notable that this case showed the clear correlation between the status of using of nivolumab and serum levels of anti-BP180 antibody. In addition, the skin eruptions in the case were mainly pruritic erosive or crusted papules and these clinical features may be the clinical characteristics of BP induced by nivolumab.

Severe Type of Erythema Multiforme (EM major) due to Administration of Anti-PD-1 Antibody Drug

“…There are many reports including skin disorders, digestive disorders (colitis, diarrhea), interstitial lung disease, myasthenia gravis, myocarditis, rhabdomyolysis, neuropathy, liver dysfunction, kidney disorder, encephalitis, endocrine disorders (Type I diabetes, thyroid dysfunction, adrenal insufficiency, hypophysitis) and so on. The incidence of skin disorders is 17-35% such as mild form of erythematous papules, toxic epidermal necrolysis, Stevens-Johnson syndrome, psoriasis-like rash, lichen-like rash, autoimmune bullous disease, etc [6,7] . Recent report indicated that the most prevalent dermatological toxicities were alopecia (27%), pruritus, and rash (10%).…”

Pathomechanism of malignant melanoma

“…The treatment of malignant melanoma has changed significantly with the launch of immune checkpoint inhibitors [1,2] . There are also reports on appropriate drug therapy [3] and measures against side effects, and safer and more effective treatment methods are being pursued [4][5][6] . For that purpose, it is necessary to update the cause of malignant melanoma.…”