Pembrolizumab-Induced Steven-Johnson Syndrome in an NSCLC Patient: A Case Report

Shan Su,Hongzhong Yang,Xinxing Hu

doi:10.4236/health.2022.141005

Abstract

Background: Immune checkpoints inhibitors (ICIs) are widely used in various therapy of tumors. With the increasing usage of them, immune-related adverse events (irAEs) have been known and become common events, especially in the dermatologic system. However, the rare and severe immune-related cutaneous adverse events (irCAEs) still lack enough knowledge. Case presentation: We described a rare case of Steven-Johnson syndrome (SJS) induced by pembrolizumab in an advanced squamous non-small cell lung cancer (NSCLC) patient. SJS is a rare irCAE that could happen at any time after immunotherapy while this case happened from the 3rd day. The patient had influence-like symptoms and several mucous lesions including oral, eye, and skin. With a gradually severer condition, a stoss therapy of intravenous immunoglobulin (IVIG) had a mild effect. It was a long process and failed to respond to usual dermatologic treatment. Conclusion: We share this case in order to enhance clinicians’ ability to early recognition and diagnosis in severe irCAEs. Early recognition and appropriate management are important to evade the termination of immunotherapy. Such severe irCAE should be paid more attention to in clinical medicine when using ICIs.

Highlights

Immune checkpoints include cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD1), and programmed cell death ligand 1 (PD-L1)
Case presentation: We described a rare case of Steven-Johnson syndrome (SJS) induced by pembrolizumab in an advanced squamous non-small cell lung cancer (NSCLC) patient
Recognition and appropriate management are important to evade the termination of immunotherapy

Summary

Introduction

Immune checkpoints include cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death 1 (PD1), and programmed cell death ligand 1 (PD-L1). Pembrolizumab is one of the anti-PD1 inhibitors which modulate tumor immunity. Many researchers had studied it and it’s a standard firstline therapy in advanced metastatic NSCLC and melanoma patients. There are lots of studies on the most common adverse events, irAE. Unlike usual mild adverse events which are greatly studied, few severe irAE is reported. We present this case of SJS induced by pembrolizumab in order to enhance clinicians’ ability to early recognition and diagnosis in such severe cutaneous adverse events (CAEs)

Case Presentation

Findings

Discussion

Conclusion