Department of Rheumatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
BMJ Case Rep. 2021 Nov 11;14(11):e244968. doi: 10.1136/bcr-2021-244968.
Few cases of programmed death-ligand 1 inhibitor-induced scleroderma have been reported and their clinical features remain unpublished. Optimal management is, therefore, unknown and an autoantibody association has yet to be identified. We present the case of a female in her 60s who developed skin thickening after starting atezolizumab for metastatic non-small cell lung cancer. Skin biopsy 7 months after symptom onset showed histological changes consistent with scleroderma. Anti-PM/SCL-75 antibody was positive. Atezolizumab was discontinued and treatment was started with mycophenolate mofetil. After 5 months, she experienced mild improvement in skin thickening. Earlier identification of this complication may limit morbidity in this disease process, which otherwise has limited treatment options. In suspected cases, obtaining scleroderma-associated autoantibodies may help with earlier diagnosis.
已报道少数程序性死亡配体 1 抑制剂诱导的硬皮病病例，但其临床特征尚未公布。因此，最佳治疗方法尚不清楚，也尚未确定自身抗体的关联性。我们报告了一例 60 多岁的女性，在开始使用阿替利珠单抗治疗转移性非小细胞肺癌后出现皮肤增厚。症状出现后 7 个月的皮肤活检显示符合硬皮病的组织学改变。抗 PM/SCL-75 抗体阳性。停用阿替利珠单抗，并开始用霉酚酸酯治疗。5 个月后，她的皮肤增厚有轻度改善。更早地识别这种并发症可能会限制这种疾病过程的发病率，因为这种疾病的治疗选择有限。在疑似病例中，获得硬皮病相关的自身抗体可能有助于早期诊断。
