Immune checkpoint inhibitors have dramatically improved patient outcomes across a variety of cancers. Recently, reports of bullous skin eruptions clinically consistent with bullous pemphigoid (BP) secondary to programmed cell death 1 (PD-1) inhibition have emerged.1 We report a case of nivolumab-induced BP with complete response to rituximab therapy.
A man in his 80s with metastatic adenocarcinoma of the lung began treatment with nivolumab, 3 mg/kg every 2 weeks. One year into therapy (26 cycles), he developed pruritus and urticarial lesions immediately after an infusion that resolved after treatment with methylprednisolone. He was subsequently treated with methylprednisolone before each nivolumab infusion, but his symptoms continued to worsen.
Sowerby L, Dewan AK, Granter S, Gandhi L, LeBoeuf NR. Rituximab Treatment of Nivolumab-Induced Bullous Pemphigoid. JAMA Dermatol. 2017;153(6):603–605. doi:10.1001/jamadermatol.2017.0091
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