Su Ying-Jie, Wu Zheng, Hou Yan-Li, Yan Meng-Xia, Ma Xiu-Mei, Lin Hou-Wen
Department of Pharmacy, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China.
Department of Radiation Oncology, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China.
Front Pharmacol. 2025 Aug 13;16:1619450. doi: 10.3389/fphar.2025.1619450. eCollection 2025.
It has been reported that immunotherapy with programmed cell death protein 1 (PD-1) inhibitors (pembrolizumab or nivolumab) can induce multiple eruptive keratoacanthomas (KAs), representing an immune-related cutaneous adverse event (ircAE).
This case report describes a 63-year-old female with recurrent cervical adenocarcinoma who developed multiple eruptive KAs and a concurrent fungal infection following treatment with the PD-1 inhibitor zimberelimab. We analyzed the etiology, diagnosis, and treatment by integrating clinical manifestations, pathological examinations, previous treatment history, and a review of the literature.
Despite an initial misdiagnosis as a fungal infection, multidisciplinary review identified KA as an ircAE. Topical corticosteroids led to resolution, and another PD-1 inhibitor was reintroduced without recurrence of cutaneous toxicity.
This is the first documented case of eruptive KA linked to zimberelimab, expanding the spectrum of PD-1 inhibitor-associated ircAEs. A concurrent fungal infection obscured the diagnosis, delaying appropriate treatment and highlighting the importance of recognizing rare ircAEs and multidisciplinary collaboration.
据报道，程序性细胞死亡蛋白1（PD-1）抑制剂（帕博利珠单抗或纳武利尤单抗）免疫治疗可诱发多发性暴发性角化棘皮瘤（KA），这是一种免疫相关的皮肤不良事件（ircAE）。
本病例报告描述了一名63岁复发性宫颈腺癌女性，在用PD-1抑制剂替雷利珠单抗治疗后出现多发性暴发性KA并并发真菌感染。我们通过整合临床表现、病理检查、既往治疗史及文献复习来分析病因、诊断和治疗。
尽管最初误诊为真菌感染，但多学科会诊确定KA为ircAE。局部使用皮质类固醇使病情缓解，重新使用另一种PD-1抑制剂后皮肤毒性未复发。
这是首例记录在案的与替雷利珠单抗相关的暴发性KA病例，拓宽了PD-1抑制剂相关ircAE的范围。并发真菌感染掩盖了诊断，延误了恰当治疗，凸显了识别罕见ircAE及多学科协作的重要性。
