Toripalimab induces exacerbation of psoriasis in an esophageal cancer patient: a case report.

BACKGROUND

Toripalimab in combination with cisplatin and paclitaxel is indicated as a first-line treatment for metastatic esophageal squamous cell carcinoma (ESCC). Toripalimab, a PD-1 inhibitor, commonly causes immune-related adverse reactions such as immune-related rash, immune-related pneumonitis, and immune-related diarrhea and colitis. This study reports a case of toripalimab-induced exacerbation of psoriasis in an esophageal cancer patient, emphasizing the need for careful monitoring and management in such treatments.

CASE PRESENTATION

A 60-year-old male patient with a history of well-controlled psoriasis without medication and no other significant medical conditions was hospitalized due to recurrence and exacerbation of psoriasis following two cycles of Toripalimab combined with cisplatin and nab-paclitaxel therapy after esophageal malignancy surgery. The psoriasis flare-up was considered to be induced by Toripalimab. After admission, the patient was treated with high-dose methylprednisolone. Upon symptom control, the steroid dosage was gradually tapered and completely discontinued over a total course of approximately eight weeks, with no recurrence throughout the tapering and discontinuation period.

CONCLUSION

For cancer patients with pre-existing autoimmune diseases, particularly those with psoriasis, comprehensive multidisciplinary evaluation is essential before initiating Toripalimab therapy. During immunotherapy cycles, specialized follow-up by dermatologists and clinical pharmacists is recommended to monitor the status of pre-existing dermatological conditions and potential adverse reactions.