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Letter to the Editor| Volume 131, P1-4, May 2020

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Toxic epidermal necrolysis accompanied by several immune-related adverse events developed after discontinuation of nivolumab

Published:April 02, 2020DOI:https://doi.org/10.1016/j.ejca.2020.02.044
      Common cutaneous events, such as lichenoid reactions and vitiligo, induced by immune checkpoint inhibitors (ICs) are typically of low grade, while toxic epidermal necrolysis (TEN) as an immune-related adverse event (irAE) is quite rare. However, gene expression profile of lesional skin from anti–programmed cell death-1 (PD-1)–related cutaneous AEs resembled Stevens-Johnson syndrome (SJS)/TEN-like pattern [
      • Goldinger S.M.
      • Stieger P.
      • Meier B.
      • Micaletto S.
      • Contassot E.
      • French L.E.
      • et al.
      Cytotoxic cutaneous adverse drug reactions during anti-PD-1 therapy.
      ], suggesting that anti–PD-1 antibody could induce SJS/TEN-like reactions at least in some patients and it should be considered during treatment with ICs. Despite the increase in usage, predictive markers for disease progression to severe irAEs remain unelucidated. We encountered a case of TEN concomitant with other irAEs developed after several months of nivolumab therapy. To understand the cytokine profile and immune regulation in our case, the cytokine levels and the state of regulatory T cells (Tregs) were analysed during the clinical course.
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