A Case of De Novo Psoriasis Secondary to Nivolumab in a Patient With Metastatic Renal Cell Carcinoma

Abstract

Immune-mediated adverse events are commonly seen with immune checkpoint inhibitors like nivolumab. Oncology specialists usually have to screen patients for risk factors for autoimmune diseases, since immune checkpoint inhibitors can potentially exacerbate these events. Some of the immune-mediated side effects include polyneuropathies, colitis, and cutaneous adverse effects. Non-specific maculopapular rash, pruritus, lichenoid reactions, eczema, and vitiligo are the most common dermatologic side effects. It is thought that these adverse events are due to the blocking of the programmed cell death protein-1 (PD-1) pathway and are mediated by the cytotoxic T cells. Psoriasis has been previously reported as a side effect in a few case reports and most commonly presented as an exacerbation of preexisting psoriasis. However, de novo psoriasis occurrence as a result of nivolumab is a rare entity, especially in a non-melanoma patient. Here, we present a case of renal cell carcinoma treated with immunotherapy with nivolumab, who developed de novo psoriasis with palmoplantar involvement.

Exacerbation of psoriasis induced by Nivolumab in a patient with stage IIIc gastric adenocarcinoma: A case report and literature review

“…When it comes to patients with psoriatic arthritis, oral methotrexate and prednisolone or apremilast seem to be effective [ [20] , [23] , [24] , [25] , [26] , [43] ]. Apremilast seems to provide a promising choice for those whose psoriasis is refractory as 5 patients got improved after being treated with apremilast [ [34] , [41] , [43] ]. Risankizumab-rzaa also helped a patient to get improved [ 42 ].…”

Perspectives on Psoriasiform Adverse Events from Immune Checkpoint Inhibitors: Lessons Learned from Our Practice

“…According to PRISMA guidelines, we performed a medical literature search across several databases (PubMed, Medline, Google Scholar) using the search terms “immune checkpoint inhibitor-induced psoriasis/psoriasiform dermatitis/psoriasis arthritis”. We identified and revised 80 relevant publications and included the most important data provided by these studies in Table S1 [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ,…”

Treatment of patients with cancer using PD‑1/PD‑L1 antibodies: Adverse effects and management strategies (Review)

“…Next, a few examples of typical clinical cases reported in recent years are described. Mullangi et al ( 65 ) reported a patient with renal cell carcinoma who developed psoriasis with nivolumab and showed involvement of the palms and soles. After a diagnosis of palmoplantar psoriasis, he was started on a regimen of topical steroids with triamcinolone acetonide.…”

“…The majority of patients with skin-related irAEs receive topical hormonal therapy with topical corticosteroids and this proves efficacious. However, for patients with severe symptoms, systemic medication should be considered ( 65 - 68 ). Urinary system-related irAEs including nephritis and cystitis are rare.…”