Systemic Scleroderma Induced by Nivolumab in Malignant Melanoma

Area of Science:

• Oncology
• Immunology
• Rheumatology

Background:

• Immune checkpoint inhibitors (ICIs) are crucial in cancer therapy.
• Immune-related adverse events (irAEs) are known complications of ICIs.
• Rheumatological irAEs, including scleroderma, require careful monitoring.

Observation:

• A 47-year-old woman with metastatic melanoma developed systemic scleroderma after nivolumab (anti-PD-1 antibody) treatment.
• The patient presented with inflammatory arthralgias, morning stiffness, cutaneous manifestations, carpal tunnel syndrome, cardiac involvement, and dyspnea.
• Positive RNA-Polymerase III antibodies were noted, supporting the diagnosis.

Findings:

• This is the first reported case of nivolumab-induced systemic scleroderma in a melanoma patient meeting classification criteria.
• Nivolumab was identified as the likely trigger for the development of systemic scleroderma.
• The clinical presentation included features typical of scleroderma and associated complications.

Implications:

• This case emphasizes the importance of recognizing rare irAEs associated with ICIs.
• Prompt diagnosis and intervention are crucial for managing ICI-induced rheumatological conditions.
• Further research is needed to understand the mechanisms and management of ICI-induced scleroderma.