Bullous pemphigoid secondary to pembrolizumab mimicking toxic epidermal necrolysis

Qiu, Connie; Shevchenko, Alina; Hsu, Sylvia

doi:10.1016/j.jdcr.2020.03.003

Cited by 14 publications

(12 citation statements)

References 17 publications

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“…Particularly, in this case, the patient presented a widespread eruption of tense bullae on an erythematous base and erosions, mimicking toxic epidermal necrolysis (TEN). 26 Another atypical presentation has been reported with palmoplantar keratoderma (PPK) in BP patients. Although dyshidrosiform pemphigoid has been shown to involve palmoplantar region, the typical histological features of these patients (lack of vesicular lesions) may categorize PPK as a novel and different presentations of BP.…”

Section: Clinical Featuresmentioning

confidence: 99%

Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients’ Assessment

Ruggiero¹,

Megna²,

Villani³

et al. 2022

CCID

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Bullous pemphigoid (BP) is the most frequent autoimmune bullous disease mainly affecting elderlies. Diagnosis usually results from clinical features, histological examination, and the quantification of circulating typical autoantibodies, due to its higher incidence in elderly patients, bullous pemphigoid treatment and management still represents a challenge due to the higher frequency of several comorbidities in this group of patients, which may also be linked to a reduced tolerance to BP treatments. Hence, an early diagnosis and a prompt correct treatment are mandatory to reach better clinical outcomes and improve as much as possible BP outcomes. Herein, we carried out a comprehensive literature review about the known clinical presentations, diagnosis, assessment and monitoring procedures used in daily clinical practice in patients with BP, to better define strategies to improve as much as possible BP clinical outcomes.

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Section: Clinical Featuresmentioning

confidence: 99%

Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients’ Assessment

Ruggiero¹,

Megna²,

Villani³

et al. 2022

CCID

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“…Histological findings of C3 and IgG depositions along the basement membrane determined by immunofluorescence are present both in pembrolizumab-induced and primary BP, indicating a similar pathophysiological mechanism. Furthermore, identification of both anti-BP230 and anti-BP180 antibodies in both conditions confirms that these entities are both clinically and pathologically undistinguishable [4]. The specific alteration that leads to the development of this form of toxicity is still unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Other cases presented in the literature of patients treated with pembrolizumab are strongly associated with other neoplasms, especially melanoma. Association with non-small cell lung cancer has only been documented, to the best of the authors’ knowledge, in one case, who presented with severe and extensive involvement resulting in widespread erosions [4].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…TEN-like presentation of BP has been rarely reported in adults [ 8 ], but to the best of our knowledge, no similar article has been published regarding this issue in pediatric population.…”

Section: Discussionmentioning

confidence: 99%

An Unusual TEN-Like Presentation of Juvenile Bullous Pemphigoid: A Diagnostic Challenge

Nikyar

Hatami

Aryanian

et al. 2022

Case Reports in Dermatological Medicine

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Bullous pemphigoid (BP) is an acquired autoimmune bullous disorder rarely seen in the pediatric population. It usually presents as large and tense bullae, predominantly distributed in the acral areas. Herein, we describe a case of childhood BP with an atypical presentation mimicking toxic epidermal necrolysis (TEN). This case shows us that juvenile BP should be considered in the differential diagnosis of TEN in children, particularly if there are unusual features and an intractable course.

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Bullous pemphigoid secondary to pembrolizumab mimicking toxic epidermal necrolysis

Cited by 14 publications

References 17 publications

Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients’ Assessment

Strategies to Improve Outcomes of Bullous Pemphigoid: A Comprehensive Review of Clinical Presentations, Diagnosis, and Patients’ Assessment

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

An Unusual TEN-Like Presentation of Juvenile Bullous Pemphigoid: A Diagnostic Challenge

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