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Published on: October 12, 2012
Neutrophil-predominant bullous pemphigoid induced by checkpoint inhibitors: A case series
Lisa M Morris1, Hal A Lewis2, Lynn A Cornelius2
1Columbia School of Medicine, University of Missouri, Columbia, Missouri.
Abstract:
Checkpoint inhibitors have been revolutionary in the treatment of metastatic melanoma, non-small-cell lung cancer, and renal cell carcinoma. By restricting negative feedback of T-cells, checkpoint inhibitors allow the immune system to identify and destroy malignant cells. This enhanced immune response is efficacious in the treatment of the aforementioned malignancies; however, it may lead to immune-related adverse events. Bullous pemphigoid (BP) is a well-documented cutaneous adverse reaction of checkpoint inhibitors, with a majority of cases reporting an eosinophil-predominant or mixed inflammatory infiltrate. We report two cases of neutrophil-predominant BP presenting in patients on checkpoint inhibitors.
Insights
Checkpoint inhibitors treat cancers like melanoma but can cause immune-related adverse events. This study highlights two cases of neutrophil-predominant bullous pemphigoid (BP), a skin reaction, linked to these therapies.
Area of Science:
- Immunology
- Dermatology
- Oncology
Background:
- Checkpoint inhibitors (e.g., PD-1/PD-L1, CTLA-4 inhibitors) enhance anti-tumor T-cell responses.
- These immunotherapies are effective against metastatic melanoma, non-small-cell lung cancer, and renal cell carcinoma.
- Immune-related adverse events (irAEs) are common side effects, including dermatological reactions.
Observation:
- Bullous pemphigoid (BP) is a known irAE associated with checkpoint inhibitors.
- Most reported BP cases exhibit eosinophil-predominant or mixed inflammatory infiltrates.
- This report details two unique cases of bullous pemphigoid with a neutrophil-predominant infiltrate.
Findings:
- The presented cases demonstrate a neutrophil-predominant inflammatory pattern in checkpoint inhibitor-associated bullous pemphigoid.
- This contrasts with the typical eosinophilic infiltrate observed in most BP cases.
- This suggests a potential variation in the immunopathogenesis of BP depending on the inciting agent.
Implications:
- Recognizing neutrophil-predominant BP is crucial for accurate diagnosis and management in patients receiving checkpoint inhibitors.
- This finding may necessitate adjustments in diagnostic criteria or treatment strategies for irAEs.
- Further research is warranted to elucidate the specific mechanisms driving this neutrophil-driven immune response.
