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Pityriasis Lichenoides et Varioliformis Acuta Developing during Pembrolizumab Treatment for Bladder Cancer.
Mizutani, Yuki; Noda, Ena; Kondo, Makoto; Hayashi, Akinobu; Yamanaka, Keiichi.
Affiliation
  • Mizutani Y; Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Japan.
  • Noda E; Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Japan.
  • Kondo M; Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Japan.
  • Hayashi A; Department of Oncologic Pathology, Graduate School of Medicine, Mie University, Tsu, Japan.
  • Yamanaka K; Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Japan.
Case Rep Dermatol ; 16(1): 116-122, 2024.
Article in En | MEDLINE | ID: mdl-39015400
ABSTRACT

Introduction:

Anti-PD-1 immunotherapies enhance T-cell responses against tumor cells by blocking the interaction between PD-1 and its ligand, PD-L1. While these therapies offer significant benefits in treating various malignancies, they can also lead to several immune-related adverse events (irAEs), most notably manifesting in the skin. Lichenoid reactions, eczema, and vitiligo are the three most prevalent forms of cutaneous irAE. Case Presentation Here, we report a rare case of a pityriasis lichenoides et varioliformis acuta (PLEVA) that developed during pembrolizumab treatment for invasive bladder cancer. A 53-year-old man, receiving pembrolizumab for invasive bladder cancer, developed erythematous papules on his legs after his 11th infusion. The skin lesions gradually spread to his entire trunk and extremities. A punch biopsy revealed several apoptotic keratinocytes and spongiosis, along with perivascular and lichenoid lymphocytic infiltration with vacuolar alteration. Immunohistochemistry showed infiltration of CD4+ and CD8+ T cells in both the epidermis and dermis. Granzyme B-positive inflammatory cells were also slightly present. From these results, he was diagnosed with PLEVA, which might be classified as a lichenoid eruption, especially based on the histological findings.

Conclusion:

We hypothesize that the anti-PD-1 antibody might lead to epidermal necrosis by amplifying the expression of cytolytic molecules such as granzyme B in CD8+ T cells.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Case Rep Dermatol Year: 2024 Document type: Article Affiliation country: Japón Country of publication: Suiza

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Case Rep Dermatol Year: 2024 Document type: Article Affiliation country: Japón Country of publication: Suiza