Saad Eltaib, Adhikari Pabitra, Antala Drashti, Abdulrahman Ahmed, Begiashvili Valiko, Mohamed Khalid, Ali Elrazi, Zhang Qishou
Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, USA.
Department of Internal Medicine, One Brooklyn Health, Interfaith Medical Center, Brooklyn, NY, USA.
J Med Cases. 2022 Sep;13(9):449-455. doi: 10.14740/jmc3992. Epub 2022 Sep 28.
Nivolumab is a humanized monoclonal anti-programmed cell death receptor-1 (PD-1) antibody that has been authorized for use in the treatment of advanced malignancies. Cutaneous reactions are the most common immune-related adverse events reported with anti-PD-1 agents, and they range broadly from mild localized reactions to rarely severe or life-threatening systemic dermatoses. The occurrence of Steven-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) with nivolumab use is an exceedingly rare phenomenon that was only documented in a handful of cases in the current literature, but it deserves careful attention as SJS/TEN may be associated with fatal outcomes. We present a case of nivolumab-induced SJS/TEN in a middle-aged female patient with metastatic gastric adenocarcinoma that was successfully treated with immunosuppressive therapy and supportive care. Prompt recognition of SJS/TEN with discontinuation of nivolumab is warranted when SJS/TEN is suspected clinically. Multidisciplinary management in a specialized burn unit is the key to improving outcomes of SJS/TEN.
纳武单抗是一种人源化单克隆抗程序性细胞死亡受体-1（PD-1）抗体，已被批准用于治疗晚期恶性肿瘤。皮肤反应是抗PD-1药物报告的最常见免疫相关不良事件，其范围广泛，从轻度局部反应到罕见的严重或危及生命的全身性皮肤病。使用纳武单抗时发生史蒂文斯-约翰逊综合征（SJS）或中毒性表皮坏死松解症（TEN）是一种极其罕见的现象，目前文献中仅记载了少数病例，但由于SJS/TEN可能与致命后果相关，因此值得密切关注。我们报告一例转移性胃腺癌中年女性患者发生纳武单抗诱导的SJS/TEN，经免疫抑制治疗和支持治疗后成功治愈。临床怀疑SJS/TEN时，应及时识别并停用纳武单抗。在专业烧伤病房进行多学科管理是改善SJS/TEN预后的关键。
