Oral lichenoid reaction showing multiple ulcers associated with anti‐programmed death cell receptor‐1 treatment: A report of two cases and published work review

Abstract

Anti-programmed cell death receptor-1 (PD-1) antibodies represent an effective treatment opinion for advanced melanoma and non-small-cell lung cancer, as well as other cancerous entities. Immune checkpoint inhibitors such as anti-PD-1 antibody result in a unique side-effect profile, commonly described as immune-related adverse events (irAE). These irAE affect the skin, gastrointestinal tract, liver, endocrine system and other organ systems. We report two cases of oral lichenoid reaction showing multiple ulcers associated with nivolumab treatment. Both patients presented with multiple ulcers covered with fibrinous plaque over the entire oral mucosa, lips and tongue. Histopathological examination of ulceration showed epithelial necrosis and subepidermal clefts with dense band-like layers of lymphohistiocytic infiltrate within the upper dermis. Nivolumab was interrupted in both cases. Case 1 responded well to topical corticosteroids. Case 2 required oral corticosteroids, however, nivolumab could be restarted without recurrence of oral ulcers. We provide a comprehensive review of reported cases of lichenoid reaction showing multiple oral ulcers associated with anti-PD-1 therapy to date. Early recognition and management may improve treatment, avoid discontinuation of life-saving therapy and maintain quality of life in these patients.

Mucosal Lichen Planus Mimicking Mucosal Lesions in Stevens-Johnson Syndrome after Nivolumab Therapy

“…These mucosal lesions were usually managed with topical corticosteroids and did not require the discontinuation of therapy (8,9). However, several cases with severe oral ulcers have been reported (10)(11)(12). Our case represents a rare and extremely severe case of mucous membrane-limited, nivolumab-induced LP, mimicking mucosal lesions in SJS.…”

A Case of Nivolumab-Associated Oral Lichenoid Lesions

“…So far only few case reports have described lichenoid lesions triggered by nivolumab and restricted to oral cavity. In all, clinical appearance was that of multiple oral ulcers with histological features of lichenoid inflammation [1]. In this report we describe a case of reticular/erosive lichenoid lesions associated with nivolumab monotherapy.…”

Oral Immune-Related Adverse Events Caused by Immune Checkpoint Inhibitors: Salivary Gland Dysfunction and Mucosal Diseases

“…OLL is also called OLR, lichenoid stomatitis, and lichen planus-like lesion [105]. In this review, OLP-like lesions were called OLR [107][108][109][110][111][112][113]. In the oral cavity, ICI-induced OLR affects the buccal mucosa, tongue, and gums and shows clinical appearances including reticular, white-lined, ulcer, erythema multiforme (EM)-like, and GVHD-like lesions.…”