Novel Presentation of Lichenoid Dermatoses Preceding Bullous Pemphigoid Secondary to Immune Checkpoint Inhibitor...

The 73-year-old non-Hispanic, African-American man with a history of renal cell carcinoma (RCC), status post-nephrectomy receiving Lenvatinib, and metastatic disease, for which he also had received nivolumab for 13½ months. An itchy eruption appeared one month after the discontinuation of nivolumab and after the beginning of axitinib therapy. Physical examination revealed pink-violaceous scaly plaques, some with trailing scales on the anterior aspect of the trunk (Figure 1), a slight erosion on the hard palate, and hypopigmentation on the hands and legs. A punch biopsy revealed spongiotic and interface dermatitis, suggesting a drug eruption. The patient was treated with triamcinolone 0.1% ointment and prednisone 60 mg, with resolution of the eruption. Because the treating oncologist was concerned that the dermatitis was caused by axitinib, the patient was switched to tivozanib; however, the patient developed a new bullous eruption two months after starting tivozanib. Physical examination revealed small papules on the hands, pink patches on the trunk, and small round crusts and tense lesions on the arms (Figure 1).