Corticosteroid-Refractory Bullous Pemphigoid Due to Immune Checkpoint Inhibitors: A Telemedicine Challenge

Area of Science:

• Oncology
• Immunology
• Dermatology

Background:

• Immune checkpoint inhibitors (ICIs) are standard cancer therapies with improved efficacy and safety profiles.
• Immune-related adverse events (irAEs) are unpredictable toxicities affecting various organs, ranging from mild to life-threatening.
• Prompt recognition and management of irAEs are crucial for patient outcomes.

Observation:

• A patient developed severe cutaneous toxicity, specifically bullous pemphigoid, after two years of nivolumab treatment.
• This rare irAE manifested in an outpatient setting during the COVID-19 pandemic.
• The toxicity was refractory to corticosteroids.

Findings:

• The case illustrates a rare presentation of severe cutaneous irAE (bullous pemphigoid) associated with nivolumab.
• Successful treatment was achieved through coordinated care involving rural providers and telemedicine.
• Corticosteroid-refractory ICI toxicity was managed effectively.

Implications:

• This case underscores the importance of recognizing rare irAEs, even late in treatment.
• Telemedicine and coordinated care models can facilitate management of ICI toxicity in diverse settings.
• Effective management strategies are vital for patients experiencing severe irAEs, improving overall prognosis.