Nivolumab-induced lichen planus pemphigoides

Area of Science:

• Oncology
• Dermatology
• Immunology

Background:

• Programmed cell death 1 (PD-1) inhibitors like nivolumab are crucial in treating various cancers, including non-small cell lung cancer.
• Cutaneous adverse events (AEs) are common with anti-PD-1 therapy, ranging from mild to severe.
• Understanding rare but severe dermatologic toxicities is essential for patient management.

Observation:

• An 87-year-old woman with stage IV non-small cell lung cancer developed a bullous eruption on her trunk and extremities.
• The patient was receiving nivolumab therapy for her cancer.
• The eruption presented as blisters on the skin.

Findings:

• Biopsy revealed a subepidermal bullous lichenoid eruption.
• Direct immunofluorescence showed a linear pattern at the basement membrane zone.
• Histopathological and immunofluorescence findings were consistent with lichen planus pemphigoides (LPP).

Implications:

• This case highlights LPP as a rare but significant cutaneous adverse event of PD-1 inhibitors.
• Prompt diagnosis and management, including drug cessation and corticosteroid treatment, are vital.
• Further research into the mechanisms of immune-related adverse events is warranted.