31789 Scleroderma associated with immune checkpoint inhibitor durvalumab

Abstract

As the use of immune checkpoint inhibitors (ICI) in cancer treatment regimens continues to rise, so has the incidence of immune-related cutaneous adverse events (irCAEs). Among irCAEs, ICI-induced scleroderma and systemic sclerosis (SSc) are rare and poorly understood. We present a case of progressive and debilitating scleroderma-like changes in a 78-year-old female being treated with durvalumab (anti-PD-L1) for squamous cell carcinoma of the lung. After 12 treatments, the patient started to develop painful skin thickening, fibrosis, and erosions of the hands, ankles, feet, and ankles that subsequently worsened after treatment completion. A full-thickness biopsy confirmed the diagnosis of fibrosing dermatitis. Laboratory values were significant for a positive homogenous ANA (1:320) and an elevated C-reactive protein. The patient’s scleroderma proceeded to involve most of her trunks, arms, and legs despite treatment with hydroxychloroquine, systemic corticosteroids, mycophenolate mofetil, intravenous immunoglobulin, and apremilast. There have been less than 10 cases of limited cutaneous and diffuse cutaneous sclerosis reported in the literature following treatment with anti-PD-1 agents. To our knowledge, this is the first case of scleroderma following anti-PD-L1 therapy. As in this patient, ICI-induced scleroderma can be recalcitrant and can significantly impact quality of life. Patients on ICIs should be carefully examined for scleroderma-like changes as early recognition and treatment initiation could reduce disease severity and lead to improved tolerance to ICIs.