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Programmed cell death protein 1 inhibitor-induced recalcitrant mixed small and medium vessel vasculitis.
- Source :
-
Dermatology online journal [Dermatol Online J] 2020 Sep 15; Vol. 26 (9). Date of Electronic Publication: 2020 Sep 15. - Publication Year :
- 2020
-
Abstract
- Pembrolizumab, a programmed cell death protein 1 (PD1) inhibitor, has been known to be associated with several adverse reactions, including immune related adverse events. In less than one percent of patients, PD1 inhibitors have been linked to the development of connective tissue disease. Patients with previously known connective tissue disease are hypothesized to be at increased risk of flares in as many as 40% of cases. A 70-year-old man with a past medical history significant for rheumatoid arthritis in remission and stage IV lung adenocarcinoma presented to the dermatology clinic after one cycle of nivolumab and eight cycles of pembrolizumab exhibiting worsening, painful bilateral lower extremity ulcers for approximately one month. On the lower legs, three large black retiform eschars and bullous purpuric plaques were observed. Vasculitis is a rare complication of PD1 inhibitor therapy, with the majority of cases reported in literature either medium vessel or large vessel vasculitis. Only glucocorticoids have proven effective for PD1-induced vasculitis and these patients generally require multi-specialty management.
- Subjects :
- Adenocarcinoma of Lung complications
Adenocarcinoma of Lung secondary
Aged
Arthritis, Rheumatoid complications
Deprescriptions
Glucocorticoids therapeutic use
Heart Failure chemically induced
Humans
Leg Ulcer drug therapy
Leg Ulcer pathology
Lung Diseases, Interstitial chemically induced
Lung Neoplasms complications
Lung Neoplasms pathology
Male
Nivolumab adverse effects
Rheumatoid Vasculitis drug therapy
Rheumatoid Vasculitis pathology
Adenocarcinoma of Lung drug therapy
Antibodies, Monoclonal, Humanized adverse effects
Immune Checkpoint Inhibitors adverse effects
Leg Ulcer chemically induced
Lung Neoplasms drug therapy
Rheumatoid Vasculitis chemically induced
Subjects
Details
- Language :
- English
- ISSN :
- 1087-2108
- Volume :
- 26
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Dermatology online journal
- Publication Type :
- Academic Journal
- Accession number :
- 33054944