Infections Simulating Immune Checkpoint Inhibitor Toxicities: Uncommon and Deceptive

Gudiol, Carlota; Hicklen, Rachel S; Okhyusen, Pablo C; Malek, Alexandre; Kontoyiannis, Dimitrios P.

doi:10.1093/ofid/ofac570

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…Further, self-destruction of the skin metastatic lesions and the subsequent skin infection may trigger the development of skin irAEs. However, it was reported that the associations with viral and bacterial infections are considered rare and deceptive [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

PD-L1 expression in keratinocyte and infiltration of CD4 + T lymphocyte can predict a severe type of erythema multiforme major induced by the anti-PD-1 antibody, pembrolizumab

Kadoi,

Yoshida,

Noto

et al. 2024

Int Canc Conf J

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Skin toxicity is the most common adverse event of treatment with immune check point inhibitors. Among them, erythema multiforme is a rare occurrence with a frequency of 4%, with most of the cases developing grade 1/2 disease. We experienced high grade erythema multiforme major developing with pembrolizumab treatment for anal canal cancer with extensive skin metastases. Steroid ointment was ineffective, and the skin lesions with blisters expanded to > 45% of the body surface area. The patient was at risk for symptom aggravation, and a pulse therapy with methylprednisolone and increasing the dose of oral prednisolone (1 mg/kg) were started. The skin lesions improved in 1.8 months. Unless urgent and appropriate treatments such as high dose steroid administration were conducted, the skin toxicities could not be controlled. The presence of CD4+ T cells and PD-L1+ keratinocytes in the skin biopsy might be a predictive marker of erythema multiforme major resistant to standard steroid treatment.

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Section: Discussionmentioning

confidence: 99%

PD-L1 expression in keratinocyte and infiltration of CD4 + T lymphocyte can predict a severe type of erythema multiforme major induced by the anti-PD-1 antibody, pembrolizumab

Kadoi,

Yoshida,

Noto

et al. 2024

Int Canc Conf J

View full text Add to dashboard Cite

show abstract

“…Notably, a hypothesis has been proposed through which infections might in fact be stimulators of irAEs in the absence of immune suppression. Infections can either occur coincidentally or due to a dysregulated immune response provoked by ICIs (36). In this context, such infections have been characterized as "infections due to dysregulated immunity" (36).…”

Section: Ici Administration and Risk Of Infectionmentioning

confidence: 99%

“…Infections can either occur coincidentally or due to a dysregulated immune response provoked by ICIs (36). In this context, such infections have been characterized as "infections due to dysregulated immunity" (36). The Memorial Sloan Kettering Cancer Center study mentioned above demonstrated 10 cases of Clostridioides difficile-associated diarrhea (CDAD) in patients receiving ICIs (7).…”

Section: Ici Administration and Risk Of Infectionmentioning

confidence: 99%