Pembrolizumab-Induced Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis in a Patient With Metastatic Cervical Squamous Cell Carcinoma: A Case Report

Abstract

We present a rare case of a pembrolizumab-induced Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). A 55-year-old woman with a history of metastatic cervical squamous cell carcinoma presented with a widespread mucocutaneous rash. Seventeen days after receiving her first cycle of pembrolizumab, she presented with fever, difficulty breathing, watery eyes, and painful oral ulcers. Physical examination revealed widespread erythematous papules and papulovesicles involving the trunk, upper extremity, and lower extremity and hemorrhagic plaques on the lower lip and buccal mucosa. Biopsy confirmed a diagnosis of SJS/TEN. This case highlights the importance of awareness of SJS/TEN as a possible adverse reaction for patients receiving pembrolizumab, a medication increasingly being used to treat metastatic or unresectable malignancies.

Case Report: Enfortumab Vedotin for Metastatic Urothelial Carcinoma: A Case Series on the Clinical and Histopathologic Spectrum of Adverse Cutaneous Reactions From Fatal Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis to Dermal Hypersensitivity Reaction

“…Most cases are associated with medications, typically antibiotics, but also with allopurinol and anticonvulsants ( 17 ). More recently, RAF and immune checkpoint inhibition may be associated with SJS/TEN ( 18 ). Lesions typically occur 7-21 days after drug exposure but can occur within 2 days upon re-exposure.…”

Combination therapy (toripalimab and lenvatinib)-associated toxic epidermal necrolysis in a patient with metastatic liver cancer: A case report

“…Pruritic maculopapular rashes, the majority of which are self-limiting, represent the most frequent cutaneous irAE, occurring in more than 1/3 of patients who receive immunotherapy[ 10 ]. There are few cases of TEN associated with PD-1 inhibitors, such as nivolumab and pembrolizumab[ 11 - 13 ]. Toripalimab was introduced into practice in recent years and widely adopted, especially in China, while no cases of TEN associated with toripalimab have been reported in association with any cancer condition.…”

Bullous pemphigoid secondary to pembrolizumab mimicking toxic epidermal necrolysis

“…Although much remains to be discovered about the adverse effects of antiePD-1 drugs, the number of reported cases of these medications precipitating SJS/TEN in patients is similar in number to reports of BP. 4,5,16 Because of stark differences in the prognosis of BP and SJS/TEN, early differentiation of BP from SJS/TEN could lead to a drastic improvement in patient outcome. In the context of pembrolizumab-induced BP, the most helpful distinguishing features are serology/ histopathology, the presence of pruritus, the absence of fever, and chronicity, especially in relation to pembrolizumab treatment initiation.…”