Atypical presentations of bullous pemphigoid: Clinical and immunopathological aspects

Cozzani, Emanuele; Gasparini, Giulia; Burlando, Martina; Drago, Francesco; Parodi, Aurora

doi:10.1016/j.autrev.2015.01.006

Cited by 81 publications

(91 citation statements)

References 134 publications

(144 reference statements)

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“…For example, BP is unusual in a 40-year-old patient such as patient 4 (BP typically affects those 70 years of age or older. 33 In addition, the blisters on this patient’s skin improved but were persistent up to 4 months after discontinuation of the anti-PD-1 agent, which is consistent with a previous study of immunobullous eruptions associated with anti-PD-1 therapy and in contrast to other types of drug-related BP. 12 …”

Section: Discussionsupporting

confidence: 90%

Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade

Kaunitz¹,

Loss²,

Rizvi³

et al. 2017

American Journal of Surgical Pathology

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Cutaneous eruptions are among the most common immune-related adverse events (irAEs) associated with anti-PD-1/PD-L1 therapy, and are often clinically and histologically characterized as lichenoid. Non-lichenoid patterns may also occur and are likely to be encountered by surgical pathologists, given the increasing clinical use of these agents. The purpose of this study is to describe the histopathologic features of non-lichenoid cutaneous irAEs from patients receiving anti-PD-1/PD-L1 therapies for a variety of underlying advanced malignancies. Sixteen patients with 17 biopsied eruptions were included from two academic institutions with extensive experience administering and monitoring responses to immune checkpoint blockade as well as treating the potential side effects. Eruptions occurred a median of 10 days (range 1 day to 11.4 months) after treatment initiation. Nearly half of specimens demonstrated either a psoriasiform/spongiotic or an urticarial-type reaction pattern on histologic review. Patterns consistent with Grover’s disease, bullous pemphigoid, and granulomatous dermatitis were also observed. Nearly two-thirds of patients required systemic corticosteroids for treatment of the cutaneous irAE, and 19% of patients discontinued immunotherapy due to their skin eruptions. 75% of patients showed an objective antitumor response. The diverse array of non-lichenoid cutaneous irAE presented here should reflect and inform the scope of histologic patterns encountered by the practicing surgical pathologist. Such eruptions are seen in patients with a variety of underlying tumor types, many of whom ultimately demonstrate a favorable response to immune checkpoint blockade.

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Section: Discussionsupporting

confidence: 90%

Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade

Kaunitz¹,

Loss²,

Rizvi³

et al. 2017

American Journal of Surgical Pathology

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show abstract

“…2 Although usually mild, anti-PD-1/anti-PD-L1 therapy-induced skin toxicity has a reported incidence of 30-40%. 6 BP is diagnosed via skin biopsy with hematoxylin and eosin in combination with direct immunofluorescence (DIF) and/or serum indirect immunofluorescence (IIF). 2,5 In recent years, checkpoint inhibitors have also been associated with the induction of autoimmune blistering disorders, such as BP.…”

Section: Introductionmentioning

confidence: 99%

A review of bullous pemphigoid associated with PD‐1 and PD‐L1 inhibitors

et al. 2018

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“…At molecular levels, the BMZ contains a mixture of structural 116 components and antigens including collagen VII, which is the major 117 structural component of anchoring fibrils, and collagen IV, which is a 118 major ubiquitous component of vertebrate basement membranes. 119 Laminins, which exist in various molecular forms as abundant non- 120 collagenous glycoproteins of basement membranes, are heterotrimers 121 consisting of alpha, beta and gamma chains [3,6]. 122 Hemidesmosomes, together with the anchoring filaments, form 123 the hemidesmosomes anchoring filament complex, which plays an im- group of diseases and only a few describe the epidemiological features 156 of the whole spectrum of autoimmune diseases in particular population.…”

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confidence: 99%