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Pembrolizumab-Induced Acral Vasculitis.

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Immune checkpoint inhibitors (ICIs) can cause rare but severe vasculitis. Early detection and stopping ICIs are crucial for managing this adverse event and improving patient outcomes.

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Area of Science:

  • Oncology
  • Immunology
  • Dermatology

Background:

  • Immune checkpoint inhibitors (ICIs) are effective cancer therapies activating the immune system.
  • Immune-related adverse events (irAEs) can occur due to nonspecific immune activation.
  • Vasculitis is a rare (<1%) but serious irAE associated with ICI treatment.

Purpose of the Study:

  • To report two cases of pembrolizumab-induced acral vasculitis.
  • To discuss the incidence, pathophysiology, clinical features, treatment, and prognosis of ICI-induced vasculitis.
  • To raise awareness of this potentially fatal irAE.

Main Methods:

  • Case identification at an academic institution.
  • Review of clinical presentation and treatment course for two patients with ICI-induced vasculitis.
  • Literature review on ICI-induced vasculitis.

Main Results:

  • Two patients with advanced cancers (lung adenocarcinoma, oropharyngeal cancer) developed antinuclear antibody-positive acral vasculitis after pembrolizumab treatment.
  • Both patients experienced dry gangrene and poor outcomes.
  • ICI-induced vasculitis is rare, potentially fatal, and requires prompt recognition.

Conclusions:

  • Pembrolizumab can induce acral vasculitis, a rare and severe irAE.
  • Early diagnosis and cessation of ICIs are critical for managing ICI-induced vasculitis.
  • Awareness and prompt management are essential to improve outcomes for patients experiencing this rare adverse event.