Generalized bullous mucocutaneous eruption mimicking Stevens-Johnson syndrome in the setting of immune checkpoint inhibition: A multicenter case series

Abstract

To the Editor: Although dermatologic immune-related adverse events from immune checkpoint inhibitors (ICIs) are usually mild, severe reactions can occur. 1 Chen C.B. Wu M.Y. Ng C.Y. et al. Severe cutaneous adverse reactions induced by targeted anticancer therapies and immunotherapies. Cancer Manag Res. 2018; 10: 1259-1273 Crossref PubMed Scopus (71) Google Scholar Sparse case reports document unusual, late-onset Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) from ICI use, 2 Salati M. Pifferi M. Baldessari C. et al. Stevens-Johnson syndrome during nivolumab treatment of NSCLC. Ann Oncol. 2018; 29: 283-284 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar ,3 Nayar N. Briscoe K. Fernandez-Peñas P. Toxic epidermal necrolysis-like reaction with severe satellite cell necrosis associated with nivolumab in a patient with ipilimumab refractory metastatic melanoma. J Immunother. 2016; 39: 149-152 Crossref PubMed Scopus (82) Google Scholar labeling it “TEN-like reaction.” 3 Nayar N. Briscoe K. Fernandez-Peñas P. Toxic epidermal necrolysis-like reaction with severe satellite cell necrosis associated with nivolumab in a patient with ipilimumab refractory metastatic melanoma. J Immunother. 2016; 39: 149-152 Crossref PubMed Scopus (82) Google Scholar We report 7 cases representing a distinct entity of a generalized bullous eruption mimicking ICI-related SJS/TEN, which we name progressive immunotherapy-related mucocutaneous eruption (PIRME). Calling for an alternative framework for this toxicity, we propose this more decisive terminology. Immune checkpoint inhibitor-related Stevens-Johnson syndrome/toxic epidermal necrolysis-like reactionsJournal of the American Academy of DermatologyVol. 85Issue 2PreviewTo the Editor: We read with interest the article by Molina et al1 that presented a series of 7 patients who developed Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)-like reactions in association with immune checkpoint inhibitors (ICI). The authors proposed the terminology “progressive immunotherapy-related mucocutaneous eruption” to differentiate this reaction from the classic SJS/TEN based on certain differences in the clinical manifestations such as delayed onset from ICI initiation, mild initial presentation, rare ocular involvement, and a benign and favorable course. Full-Text PDF