Mucous membrane pemphigoid in a patient treated with nivolumab for Hodgkin's lymphoma

Durmus, Öykü; Gülseren, Duygu; Akdoğan, Neslihan; Gököz, Özay

doi:10.1111/dth.14109

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…More than 100 cases have been reported to date by many authors [6,7] . On the other hand, only 9 cases of MMP were reported to associate ICIs (Table 1) [8][9][10][11][12][13][14][15] . Five out of nine patients were female.…”

Section: Discussion and Literature Reviewsmentioning

confidence: 99%

Mucous membrane pemphigoid involving palmoplantar lesions that developed during adjuvant nivolumab for malignant melanoma: A rare case and literature review

Takata,

Usui,

Kogame

et al. 2023

Trends Immunother.

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Immune checkpoint inhibitors (ICIs), such as nivolumab, which target anti‐programmed cell death-1 (PD-1), have been applied to a variety of cancers and have caused immune‐related adverse events (irAEs). Although an association between ICIs and bullous pemphigoid and mucosal pemphigoid (MMP) has been reported, the complex mechanisms underlying PD-1 inhibition‐induced autoantibody production and autoimmunity remain unelucidated. In this report, we present a unique case of MMP involving the palmoplantar lesions during adjuvant nivolumab therapy. A Japanese woman in her 70s was treated with nivolumab for postoperative vulvar malignant melanoma; after the 12th cycle of treatment, ulcers were seen in the oral cavity, and 4 months later, tense palmoplantar blisters appeared. Microscopic examination of the palmar blister revealed subepidermal vesicles characterized by eosinophil infiltration. Immunofluorescence analysis revealed linear IgG and C3 deposits along the basement membrane; ELISA testing confirmed the presence of anti‐BP180 NC16A IgG antibody, and MMP was diagnosed. The patient’s condition gradually improved with a therapeutic regimen of corticosteroids and immunoglobulins. A review of 10 cases of ICI‐associated MMP, including the present case, revealed clinical similarities to conventional MMP; in cases of persistent oral erosions due to ICI, it is most important to consider mucositis and MMP in the framework of differential diagnosis. Besides, we suggest that we can be more suspicious of MMP by paying attention to examining the palms and soles when the patient receiving ICIs has refractory oral ulcers. This report underscores the importance of careful observation and prompt management of irAE as cancer immunotherapy evolves.

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Section: Discussion and Literature Reviewsmentioning

confidence: 99%

Mucous membrane pemphigoid involving palmoplantar lesions that developed during adjuvant nivolumab for malignant melanoma: A rare case and literature review

Takata,

Usui,

Kogame

et al. 2023

Trends Immunother.

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“…Occasionally, BP exhibits severe erosive erythemas mimicking toxic epidermal necrolysis (TEN). 41 In addition, as rare variants, lichen planus pemphigoides, 42–45 and mucous membrane pemphigoid 46 have been reported.…”

Section: Various Mucocutaneous Disordersmentioning

confidence: 99%

Skin Manifestation Induced by Immune Checkpoint Inhibitors

Yamamoto¹

2022

CCID

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In accordance with recent therapeutic progress of immune checkpoint inhibitors for certain cancers, various disorders are induced as immune-related adverse events (irAEs) affecting the skin, gut, thyroid gland, lung, and liver. Among such irAEs, mucocutaneous manifestation is the most common. Cutaneous manifestations are categorized into several groups, ie, inflammatory reactions, immunobullous reactions, alterations of epidermal keratinocytes, and alterations of epidermal melanocytes; however, there are additionally various cutaneous toxicities, unclassified into those groups. Blocking of programmed cell death 1 (PD-1)/programmed cell death ligand 1(PDL1) can lead to the induction of autoimmune reaction, via activation of cytotoxic T cells, inhibition of regulatory T cell function, and alteration of cytokine balance. Similarly, blockade of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) reduces the suppressive function of regulatory T cells. Due to those mechanisms, various autoimmune conditions can be induced, in addition to nonspecific drug eruptions. Dermatologists should be aware of various types of those mucocutaneous manifestations, either common or rare, as well as the management of such conditions. Herein, various mucocutaneous manifestations of irAEs and cases involving Japanese patients have been described, based on a single institute’s experience.

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Nivolumab

2021

Reactions Weekly

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Mucous membrane pemphigoid in a patient treated with nivolumab for Hodgkin's lymphoma

Cited by 5 publications

References 8 publications

Mucous membrane pemphigoid involving palmoplantar lesions that developed during adjuvant nivolumab for malignant melanoma: A rare case and literature review

Mucous membrane pemphigoid involving palmoplantar lesions that developed during adjuvant nivolumab for malignant melanoma: A rare case and literature review

Skin Manifestation Induced by Immune Checkpoint Inhibitors

Nivolumab

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