Subject(s)
Pemphigoid, Bullous , Humans , Pemphigoid, Bullous/therapy , Treatment Outcome , PlasmapheresisSubject(s)
Hamartoma , Scrotum , Hamartoma/diagnosis , Humans , Male , Muscle, Smooth , Scrotum/diagnostic imaging , Scrotum/surgeryABSTRACT
Nivolumab and pembrolizumab are humanized IgG4 monoclonal antibodies against programmed cell death 1 (PD-1). Although these agents are effective in treating advanced melanoma, non-small-cell lung carcinoma, and other types of cancers, various adverse events have been reported. Cutaneous adverse events are particularly prevalent and, while granulomatous/sarcoid-like reactions are uncommon, they are increasingly recognized as immune-related adverse events associated with immune checkpoint inhibitors. Herein, we report two cases of granulomatous/sarcoid-like reaction with foreign material, mimicking metastatic malignancy after PD-1 inhibitor treatment. Clinicians should be aware of the existence of cutaneous lesions and perform biopsy if needed to prevent misdiagnosis and unnecessary adjustments to immunotherapy.
Subject(s)
Drug Eruptions , Melanoma , Neoplasm Proteins/antagonists & inhibitors , Nivolumab/adverse effects , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Rectal Neoplasms , Aged , Drug Eruptions/diagnosis , Drug Eruptions/metabolism , Drug Eruptions/pathology , Humans , Male , Melanoma/diagnosis , Melanoma/drug therapy , Melanoma/metabolism , Melanoma/pathology , Neoplasm Metastasis , Neoplasm Proteins/metabolism , Nivolumab/administration & dosage , Programmed Cell Death 1 Receptor/metabolism , Rectal Neoplasms/diagnosis , Rectal Neoplasms/drug therapy , Rectal Neoplasms/metabolism , Rectal Neoplasms/pathologyABSTRACT
Pemphigus vulgaris (PV) is an autoimmune blistering disease elicited by anti-desmoglein (DsG) 3 antibody. Although skin lesions tend to be distributed over the entire body, in some patients, they are confined to a restricted area. We report two patients who presented with long-lasting localized PV without detectable anti-DsG antibodies after suffering antibody-positive systemic PV. Initial treatment with prednisolone (PSL) was successful in both patients, but a local relapse occurred on the cheek or lower lip after a reduction in the PSL dose. Biopsy of the localized lesions showed suprabasal acantholysis; no serum DsG antibodies were found. Local immunosuppression therapy was effective in both patients. Based on our findings, we suggest that localized PV without detectable antibodies can develop after systemic PV.
