Tsujita Tomohiro, Takahashi Syogo, Oinuma Toshimichi, Hata Norihiko
Dept. of Respiratory Internal Medicine, Kawaguchi Municipal Medical Center.
Gan To Kagaku Ryoho. 2018 Nov;45(11):1641-1644.
The patient was a 66-year-old male. Following surgery for pulmonary adenocarcinoma in the upper right lobe and adjuvant chemotherapy, the patient relapsed. We carried out treatment using the immune checkpoint inhibitor pembrolizumab (KEYTRUDA®)for high expression of PD-L1. Following the first administration, severe drug eruption occurred and despite temporary improvement seen by intravenous infusion of steroids in combination with oral administration and external use thereof, it relapsed in the early stages and toxic epidermal necrosis developed. Skin problems were improved by multidisciplinary treatments such as gammaglobulin therapy, systemic steroid administration, and broad-spectrum antibiotics. There were no reports oftoxic epidermal necrosis occurring during pembrolizumab administration for lung cancer. This case went through a unique course in which the disease relapsed into a more severe condition at an early stage following temporary remission.
该患者为66岁男性。右上叶肺腺癌手术后接受辅助化疗,之后病情复发。因PD-L1高表达,我们使用免疫检查点抑制剂帕博利珠单抗(可瑞达®)进行治疗。首次给药后,发生了严重的药物疹,尽管通过静脉输注类固醇并联合口服及外用类固醇后病情暂时好转,但在早期仍复发,并发展为中毒性表皮坏死松解症。通过丙种球蛋白治疗、全身性类固醇给药和广谱抗生素等多学科治疗,皮肤问题得到改善。此前尚无在肺癌患者使用帕博利珠单抗期间发生中毒性表皮坏死松解症的报道。该病例经历了一个独特的病程,即在暂时缓解后的早期病情复发并发展为更严重的状况。