Ipilimumab/nivolumab‐induced pseudolymphoma in a patient with malignant melanoma

Abstract

Combination therapy with ipilimumab and nivolumab is an adjuvant treatment approach for metastatic melanoma that boasts increased 3‐year survival when compared with a single immunotherapy agent. Combination therapy, however, is associated with increased toxicities, especially cutaneous side‐effects. Here we present a patient with metastatic melanoma and a sudden eruption of painful nodules on the face and arms 10 days after the administration of the fourth dose of combination ipilimumab/nivolumab. Biopsies demonstrated lymphoid hyperplasia, not clinically or pathologically consistent with an infectious, malignant or autoimmune etiology; a diagnosis of pseudolymphoma secondary to ipilimumab/nivolumab was made. After a steroid taper, the lesions resolved, and the patient was restarted on nivolumab monotherapy 2 weeks later without recurrence of symptoms or disease.

Drug‐induced cutaneous pseudolymphoma: A systematic review of the literature

“…We found 12 cases of monoclonal antibody-induced CPLs. Monoclonal antibodies responsible for causing CPL were: infliximab in three (3.3%), [20][21][22] ipilimumab in two (2.2%), 23,24 infliximab and adalimumab in two (2.2%), 22,25 secukinumab in one (1.1%), 26 mogamulizumab in one (1.1%), 27 tocilizumab in one (1.1%), 28 adalimumab in one (1.1%) 22 and cetuximab in one (1.1%). 29 Eleven of twelve (91.6%) cases had T-cell pattern infiltrations and one of twelve (8.3%) had mixed B and T-cell lymphocyte patterns.…”

Análise dos rearranjos gênicos de cadeias pesada e leves da imunoglobulina pela técnica de reação em cadeia da polimerase no auxílio diagnóstico de processos linfoproliferativos cutâneos de células B

“…Mas sim, o diagnóstico é fundamentado em uma constelação de achados clínicos, exclusão de linfomas cutâneos e outros possíveis etiologias que resultam no diagnóstico de PLC (Ayoubi et al, 2020). Mesmo assim, uma porcentagem substancial de casos suspeitos de PLC permanecem indefinidos, uma vez que a diferenciação de linfoma cutâneo pode ser muito difícil (Bergman, 2010).…”