Interstitial granulomatous dermatitis and granulomatous arteritis in the setting of PD‐1 inhibitor therapy for metastatic melanoma

Abstract

Checkpoint inhibition has become an important target in the management of malignant melanoma. As anti-CTLA4 inhibitors and anti-PD1 antibodies are increasingly utilized, reports of immune-related adverse events (IRAEs) are becoming more frequent. Common noted cutaneous IRAEs are morbilliform, lichenoid, bullous, granulomatous, psoriasiform, and eczematous eruptions. We report a case of interstitial granulomatous dermatitis and granulomatous arteritis in the setting of nivolumab (anti-PD1) monotherapy for metastatic melanoma. There are many different causes for granulomatous vasculitis, such as herpes virus infection, lymphoproliferative disorders, systemic vasculitis, and inflammatory bowel disease. This report adds to the growing literature on granulomatous IRAEs due to checkpoint inhibition. K E Y W O R D S checkpoint inhibitors, granulomatous vasculitis, immune-related adverse events, interstitial granulomatous dermatitis, nivolumab

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

“…Additionally, medium or small vessels can be affected, with cases of granulomatosis with polyangiitis (GPA) [59,60], eosinophilic granulomatosis with polyangiitis (EGPA) [61] and cryoglobulinemic vasculitis [62] having been reported. Cutaneous granulomatous [63,64] and leukocytoclastic vasculitides [65] have also been described. ICI-induced vasculitis can present as isolated vasculitis affecting the central nervous system (PACNs) [66][67][68], the peripheral nervous system [69,70], the retina [71][72][73], the testicles [74] and the uterus [75].…”

Rheumatic Manifestations and Diseases From Immune Checkpoint Inhibitors in Cancer Immunotherapy

“…Isolated vasculitis can affect the retina and testicles (56,57). Cutaneous granulomatous (58) and leukocytoclastic vasculitides (59) have also been shown in several studies. In addition, small-vessel vasculitis was also detected in patients receiving ICIs, such as eosinophilic granulomatosis with polyangiitis (60) and cryoglobulinemic vasculitis (61).…”

Dermatitis granulomatosas reactivas: dermatitis granulomatosa intersticial y dermatitis granulomatosa neutrofílica en empalizada

“…Es menos frecuente que la DGNE y la DGI sean inducidas por fármacos como antagonistas del calcio, hipolipemiantes, IECA, antihistamínicos, anticonvulsivos, antidepresivos, colchicina, metotrexato, anti-TNF (adalimumab, infliximab, etanercept) e inhibidores del PD-1 5,8,14,15 . Esto debe diferenciarse de la DGIF descripta por Magro et ál., también desencadenada por fármacos, pero que se distingue de las otras dos por la presencia, en los infiltrados dérmicos, de abundantes eosinófilos, reacción de interfase dermoepidérmica con vacuolización basal, grados variables de atipia linfoide, y ausencia de vasculitis y de mucina 16 .…”