Department of Pulmonary and Critical Care Medicine, Air Force Medical Center, Beijing, China.
Department of Dermatology, Air Force Medical Center, Beijing, China.
Front Immunol. 2021 Sep 14;12:731774. doi: 10.3389/fimmu.2021.731774. eCollection 2021.
The programmed cell death protein 1 inhibitor pembrolizumab, an immune checkpoint inhibitor, has subsequently been approved for the treatment of a wide variety of malignant tumors. Compared with conventional chemotherapy, immunotherapy is associated with a unique set of immune reactions, known collectively as immune-related adverse events. Although often mild, dermatologic toxicity can occasionally be high grade and potentially life-threatening. Here we describe a rare case of bullous pemphigoid (BP) associated with pembrolizumab. A 79-year-old male patient presented with scattered erythema, papules, blisters, and pruritus after pembrolizumab treatment. Then, the rash gradually aggravated and spread to the whole body. The extensive edematous erythema, blisters, bullae, and blood blisters were loose and easy to rupture, forming an erosive surface and with pruritus and obvious pain. The hemidesmosomal protein BP180 (type XVII collagen) was detectable in the serum, and the histological examination diagnosis was bullous pemphigoid. After 10 days of glucocorticoid (methylprednisolone, iv, 80 mg/day) treatment, new blister formation ceased. We need to increase the awareness on and facilitate the earlier identification of the cutaneous adverse effects of BP with immunotherapy so that treat can begin early in order to limit the duration and severity of toxicity.
程序性死亡蛋白 1 抑制剂帕博利珠单抗是一种免疫检查点抑制剂，随后被批准用于治疗多种恶性肿瘤。与传统化疗相比，免疫疗法与一组独特的免疫反应有关，统称为免疫相关不良事件。虽然通常较轻，但皮肤毒性偶尔也可能是高级别且有潜在生命危险的。在这里，我们描述了一例与帕博利珠单抗相关的罕见大疱性类天疱疮 (BP) 病例。一名 79 岁男性患者在接受帕博利珠单抗治疗后出现散在红斑、丘疹、水疱和瘙痒。然后，皮疹逐渐加重并蔓延至全身。广泛的水肿性红斑、水疱、大疱和血疱松弛且容易破裂，形成糜烂表面，并伴有瘙痒和明显疼痛。血清中可检测到桥粒蛋白 BP180（XVII 型胶原），组织学检查诊断为大疱性类天疱疮。糖皮质激素（甲基强的松龙，iv，80mg/天）治疗 10 天后，新的水疱形成停止。我们需要提高对免疫治疗相关 BP 皮肤不良事件的认识，并促进早期识别，以便尽早开始治疗，从而限制毒性的持续时间和严重程度。
