ABSTRACT
Checkpoint inhibition has become an important target in the management of malignant melanoma. As anti-CTLA4 inhibitors and anti-PD1 antibodies are increasingly utilized, reports of immune-related adverse events (IRAEs) are becoming more frequent. Common noted cutaneous IRAEs are morbilliform, lichenoid, bullous, granulomatous, psoriasiform, and eczematous eruptions. We report a case of interstitial granulomatous dermatitis and granulomatous arteritis in the setting of nivolumab (anti-PD1) monotherapy for metastatic melanoma. There are many different causes for granulomatous vasculitis, such as herpes virus infection, lymphoproliferative disorders, systemic vasculitis, and inflammatory bowel disease. This report adds to the growing literature on granulomatous IRAEs due to checkpoint inhibition.
Subject(s)
Drug Eruptions , Melanoma , Neoplasm Proteins/antagonists & inhibitors , Nivolumab , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Skin Neoplasms , Vasculitis, Central Nervous System , Drug Eruptions/metabolism , Drug Eruptions/pathology , Female , Humans , Melanoma/drug therapy , Melanoma/metabolism , Melanoma/pathology , Middle Aged , Neoplasm Metastasis , Nivolumab/administration & dosage , Nivolumab/adverse effects , Skin Neoplasms/drug therapy , Skin Neoplasms/metabolism , Skin Neoplasms/pathology , Vasculitis, Central Nervous System/chemically induced , Vasculitis, Central Nervous System/metabolism , Vasculitis, Central Nervous System/pathology , Melanoma, Cutaneous MalignantABSTRACT
BACKGROUND: A number of specialized educational programs (i.e., simulation fellowships) have been developed, but their characteristics are not well known. OBJECTIVE: We studied the characteristics of existing simulation fellowship programs. METHODS: Fellowships were identified and characteristics determined from public sources and direct survey. RESULTS: Seventeen fellowships were identified. The sponsoring academic unit was emergency medicine in 53%, pediatric emergency medicine in 7%, urology in 7%, emergency medicine/anesthesiology in 13%, and interdisciplinary units in 20%. Fifty-nine percent were open to emergency medicine residency graduates, and 12% were open to either anesthesia or emergency medicine graduates, or 12% to physician graduates of any specialty. One fellowship was open to pediatric emergency medicine graduates only and another specifically to surgically trained physicians. Seventy-eight percent indicated that fellows were required to work clinically as part of the fellowship, averaging 19 hours per week. Twenty-seven percent of fellowships were 1 year in length and 13% were 2 years. Common (47%) was the option of a 1- or 2-year fellowship, with those in the 2-year track earning a graduate degree or certificate. Most programs accepted a single fellow each year, and some accepted either one or two. Fellowships reported a high fill rate. CONCLUSIONS: The 17 identified fellowship programs differed greatly in length, sponsoring academic unit, and prerequisites. The majority require their fellows to provide clinical service. Fellowships reported a high fill rate, suggesting substantial interest in simulation among current residents.
