Pembrolizumab-associated mucous membrane pemphigoid in a patient with Merkel cell carcinoma

Haug, V.; Behle, Valeria; Benoit, Sandrine; Kneitz, Hermann; Schilling, Bastian; Goebeler, Matthias; Gesierich, Anja

doi:10.1111/bjd.16780

Cited by 37 publications

(23 citation statements)

References 6 publications

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“…3 Skin lesions, which are found in 25% of cases, are often limited and confined to the face and scalp, as in our second patient. [4][5][6] Our first case was striking, since he developed oral MMP in combination with lichenoid cutaneous lesions. [4][5][6] Our first case was striking, since he developed oral MMP in combination with lichenoid cutaneous lesions.…”

Section: Mucous Membrane Pemphigoid and Lichenoid Reactions After Immmentioning

confidence: 87%

“…1 However, it causes adverse effects, including lichenoid reactions. [2][3][4][5][6] We describe two new cases of pembrolizumab-triggered MMP; one of which was associated with cutaneous lichenoid lesions. [2][3][4][5][6] We describe two new cases of pembrolizumab-triggered MMP; one of which was associated with cutaneous lichenoid lesions.…”

Section: Mucous Membrane Pemphigoid and Lichenoid Reactions After Immmentioning

confidence: 99%

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Secukinumab for patients with plaque psoriasis affected by multiple sclerosis: a mini‐review with a representative case report

Venturini

Zanca

Venturuzzo

et al. 2019

Acad Dermatol Venereol

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remain high on the differential diagnosis. 2,8 Notably, peristomal skin complications are reported as high as 67%, and almost all patients with an ostomy experience some degree of irritant dermatitis. 2,9 Applying proper wound care principles to address devitalized tissue, infection and moisture imbalance are vital in the treatment of these other conditions. 10 We believe our patients' symptoms initially developed as an irritant dermatitis but were further exacerbated by poor wound healing and chronic irritation. If the clinical suspicion for PPG is low, we encourage an initial trial of aggressive wound care. After initiating proper wound care, clinical improvement without the use of immunosuppressants should raise suspicion for other common aetiologies of peristomal ulceration.

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Section: Mucous Membrane Pemphigoid and Lichenoid Reactions After Immmentioning

confidence: 87%

Section: Mucous Membrane Pemphigoid and Lichenoid Reactions After Immmentioning

confidence: 99%

Secukinumab for patients with plaque psoriasis affected by multiple sclerosis: a mini‐review with a representative case report

Venturini

Zanca

Venturuzzo

et al. 2019

Acad Dermatol Venereol

View full text Add to dashboard Cite

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“…In addition, a pharmacovigilance analysis performed on the Adverse Event Reporting System database of Food and Drug Administration recently demonstrated an increased risk to develop BP in patients treated by pembrolizumab or nivolumab (17); this signal was based on 35 case reports. Two cases of mild MMP limited to the oral cavity have also been described in patients under anti-PD1 therapy (9, 12). Apart from immune-mediated subepithelial blistering diseases, atypical suprabasal acantholytic dermatosis represents another emerging group of checkpoint inhibitor related skin toxicities.…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic Pemphigus Revealed by Anti-programmed Death-1 Pembrolizumab Therapy for Cutaneous Squamous Cell Carcinoma Complicating Hidradenitis Suppurativa

et al. 2019

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A 64-year-old patient developed a widespread autoimmune mucocutaneous blistering disease 3 weeks after the initiation of the anti-programmed death-1 (anti-PD-1) pembrolizumab therapy administered for a locally advanced cutaneous squamous cell carcinoma (SCC) of the buttocks arising from hidradenitis suppurativa. A diagnosis of paraneoplastic pemphigus (PNP) was made based on the presence of a suprabasal acantholysis associated with intercellular deposits of immunoglobulin G and C3 on basement membrane zone. Analysis of the patient's sera was positive on monkey bladder and detected circulating antibodies against desmoglein 3 and desmoplakin I prior to the initiation of pembrolizumab. At that time, the patient had few localized blisters limited to the peri-tumoral skin of the buttocks with acantholysis but without in vivo immune deposits. Pembrolizumab therapy was discontinued and a complete remission of PNP was obtained using oral steroids. Reintroduction of pembrolizumab resulted in flare of PNP. Given the close temporal relation between pembrolizumab initiation and the subsequent clinical expression of a widespread PNP, the patient was diagnosed with pre-existing subclinical PNP exacerbated by PD-1 inhibitor. The extreme rarity of PNP in the setting of cutaneous SCC and the effects of challenge, dechallenge, and rechallenge of pembrolizumab argue in favor of a checkpoint inhibitor related adverse effect. Our case is the first PNP associated with anti-PD-1 therapy and serological follow-up suggest that one infusion of pembrolizumab is sufficient to allow clinical expression of underlying pemphigus auto-immunity.

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“…We examined the intrinsic accountability of pembrolizumab therapy on MMP induction in our patient with metastatic melanoma because of its extrinsic accountability based on the following reports: (i) MMP and BP have immunological similarities ( 7 ); (ii) intrinsic accountability of anti PD-1/PD-L1 treatments on BP induction: 27 BP have been reported as case reports or short series ( 32 – 49 ) and two BPs listed as adverse drug reaction in two large trials with anti PD-1 ( 50 , 51 ); (iii) recently, one pembrolizumab-associated MMP case report ( 52 ), and (iv) some of the anti PD-1/PD-L1-associated BPs had atypical clinical phenotypes ( 33 – 35 , 42 , 47 ).…”

Section: Discussionmentioning

confidence: 99%

Mucous Membrane Pemphigoid, Bullous Pemphigoid, and Anti-programmed Death-1/ Programmed Death-Ligand 1: A Case Report of an Elderly Woman With Mucous Membrane Pemphigoid Developing After Pembrolizumab Therapy for Metastatic Melanoma and Review of the Literature

et al. 2018

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An 83-year-old patient developed erosions and a blister of the gingival mucous membrane, 6 months after discontinuation of the anti-programmed death-1 (anti PD-1) pembrolizumab therapy administered for 10 months for a metastatic melanoma. A diagnosis of mild mucous membrane pemphigoid (MMP) was made. Complete remission of MMP was rapidly obtained with minimal therapy (doxycycline). MMP remained in complete remission after a 3-month follow-up since discontinuation of the doxycycline therapy and no evidence of relapse of the melanoma was observed after a 14-month follow-up since discontinuation of the pembrolizumab therapy. The widespread use of anti PD-1 and anti-programmed death-ligand-1 (PD-L1) in several malignancies reveals new adverse events. MMP describes a group of chronic, inflammatory, mucous membrane-predominant, subepithelial auto-immune blistering diseases. It is clinically distinct from bullous pemphigoid another autoimmune blistering disease but shares some immunological similarities with it. Twenty-nine cases of bullous pemphigoid associated with anti PD-1/PD-L1 have been reported in the literature and one of MMP. Here, we described the case of a MMP developed after pembrolizumab and discussed the accountability of anti PD-1/PD-L1 in our case and the previous reported bullous pemphigoid and MMP cases using the Begaud system scoring.

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Pembrolizumab-associated mucous membrane pemphigoid in a patient with Merkel cell carcinoma

Cited by 37 publications

References 6 publications

Secukinumab for patients with plaque psoriasis affected by multiple sclerosis: a mini‐review with a representative case report

Secukinumab for patients with plaque psoriasis affected by multiple sclerosis: a mini‐review with a representative case report

Paraneoplastic Pemphigus Revealed by Anti-programmed Death-1 Pembrolizumab Therapy for Cutaneous Squamous Cell Carcinoma Complicating Hidradenitis Suppurativa

Mucous Membrane Pemphigoid, Bullous Pemphigoid, and Anti-programmed Death-1/ Programmed Death-Ligand 1: A Case Report of an Elderly Woman With Mucous Membrane Pemphigoid Developing After Pembrolizumab Therapy for Metastatic Melanoma and Review of the Literature

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