Widespread vitiligo and poliosis following ipilimumab–nivolumab combination therapy

Abstract

Introduction Combined immune checkpoint inhibitor therapy has been successfully used in the treatment of several malignancies. Adverse effects with the combination therapy may be more severe than the ones seen with single immune checkpoint inhibitors. Case presentation We report a unique case of a 59-year-old man of dark skin complexion who underwent treatment with intravenous ipilimumab–nivolumab every 3 weeks for metastatic malignant melanoma. After three cycles of this therapy, he developed extensive skin depigmentation that within 6 weeks, affected nearly the entire skin surface, along with progressive poliosis. Management and outcome Ipilimumab–nivolumab therapy was subsequently discontinued due to grade 3 enterocolitis requiring high-dose steroids and intravenous infliximab. About six months later, imaging studies showed a relapse of malignant melanoma. At that juncture, vitiligo affected the total body surface area, resembling albinism, along with near-total poliosis and significant photosensitivity. Pembrolizumab was tried but had to be stopped after three cycles due to the reoccurrence of grade 3 enterocolitis. Progression of malignant melanoma with new brain, lung, liver, subcutaneous, and colonic metastases led to the patient's demise. Conclusion We report a unique case of severe vitiligo and poliosis that involved total body surface area in a Caucasian man with dark complexion, resembling albinism. Further studies are warranted to evaluate the severity of dermatologic side effects with combination immune checkpoint inhibitor therapy.

Reflections and Mendelian randomization analysis of patients with vitiligo and pancreatic cancer

“…In addition, some reports have mentioned that vitiligo often appears as a symptom after targeted therapy or chemotherapy for other cancers, and its pathological mechanism has not been clari ed as of this moment. And In these cases, it is not clear whether the disease itself is responsible for the susceptibility to vitiligo, or whether the drug treatment has contributed to the development of vitiligo [21,22]. Because there are so few studies exploring the effect of vitiligo on pancreatic cancer, no rm conclusions have been reached on this issue.…”