A Case of Nivolumab-Induced Bullous Pemphigoid in a Patient with Metastatic Breast Cancer
- Author:
Jin Ju LEE
1
;
Yoon Jin CHOI
;
You Won CHOI
;
Joo Young ROH
;
Hae Young CHOI
;
Ji Yeon BYUN
Author Information
1. Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
- Publication Type:Case Report
- From:Korean Journal of Dermatology
2024;62(5):299-302
- CountryRepublic of Korea
- Language:English
-
Abstract:
Nivolumab is a checkpoint inhibitor monoclonal antibody, designed to interact with the programmed death cell receptor-1, preventing the inhibitory signaling on cytotoxic T cells. Immune checkpoint inhibitors can lead to severe cutaneous immune-related adverse events (irAEs). A 54-year-old female with a breast cancer metastasis was referred to our clinic due to diffuse cutaneous lesions of crusted erythematous patches and multiple blisters for 2 weeks. Five months before presentation, she started nivolumab/eribulin immunotherapy. Skin biopsy showed subepidermal blistering with perivascular lymphohistiocytic infiltration with eosinophils. Direct immunofluorescence showed linear deposition of immunoglobulin G and C3 along the dermoepidermal junction, consistent with bullous pemphigoid.Temporal relationship between initiation of nivolumab and skin lesion suggested the diagnosis of nivolumab-induced bullous pemphigoid. Dermatologic toxicity is the most common irAEs associated with nivolumab, but nivolumab-induced bullous pemphigoid is rare. Given the widespread use of immunotherapy, it is important to document this case to develop proper management strategies.
