PDF(Pubmed)
Abstract：
Immune checkpoint inhibitors are increasingly being used to treat various malignancies. Despite their efficacy, they are known to potentially cause immune-related adverse effects, including dermatological manifestations. A rare cutaneous immune-related adverse effect is scleroderma, which has been reported to occur with anti-programmed cell death-1 (PD-1) agents such as pembrolizumab and nivolumab. This may present with skin tightening and hardening at any point during or after immunotherapy. We present the case of a 54-year-old Caucasian woman who, following 16 doses of pembrolizumab for breast cancer, developed clinical features of scleroderma confirmed on histology. She was initially treated with oral corticosteroids, followed by oral psoralen-UVA, with poor response, but eventually improved with methotrexate. A literature review revealed 12 other cases of scleroderma following pembrolizumab treatment and 6 cases of scleroderma following nivolumab treatment. Males and females were both affected, and their ages ranged from 33 to 81 years. Scleroderma developed at different stages of pembrolizumab or nivolumab therapy. Although scleroderma is not commonly drug-induced, anti-PD-1 agents may be a rare cause and it is important to elicit an accurate drug history, including immunotherapy, in such cases.
摘要：
免疫检查点抑制剂越来越多地用于治疗各种恶性肿瘤。尽管它们的功效,已知它们可能导致免疫相关的不良反应，包括皮肤病学表现。一种罕见的皮肤免疫相关不良反应是硬皮病，据报道，抗程序性细胞死亡-1（PD-1）药物如帕博利珠单抗和纳武单抗会发生这种情况。这可能在免疫疗法期间或之后的任何时候表现为皮肤收紧和硬化。我们介绍了一个54岁的白人妇女的案例，在16剂pembrolizumab治疗乳腺癌后，在组织学上证实了硬皮病的发展临床特征。她最初接受口服皮质类固醇治疗，其次是口服补骨脂素-UVA，反应不佳，但最终甲氨蝶呤有所改善。文献综述显示，pembrolizumab治疗后硬皮病有12例，nivolumab治疗后硬皮病有6例。男性和女性都受到影响，他们的年龄从33岁到81岁不等。硬皮病在pembrolizumab或nivolumab治疗的不同阶段发展。虽然硬皮病通常不是药物引起的，抗PD-1药物可能是一个罕见的原因，重要的是要引出一个准确的用药史，包括免疫疗法,在这种情况下。
