Abstract：
In this report, we describe the case of a 28-year-old female with bilateral breast cancer in the setting of a BRCA1 mutation, who presented to dermatology with an eczematous reaction, ultimately diagnosed as a cutaneous immune-related adverse event (cirAE) secondary to an immune checkpoint inhibitor (ICI), pembrolizumab. Our case report highlights a novel therapeutic option for an eczematous cirAE: the topical JAK 1/2 inhibitor, ruxolitinib. CirAEs can occur in up to 55% of patients on ICIs, a class of medications seeing rapidly increasing use in cancer therapy, and prior research has demonstrated that ICI-induced dermatitis may involve different pathways than traditionally observed in their spontaneous counterparts. Specifically, marked Th1 skewing is noted in ICI-induced dermatitis, as opposed to a predominant Th2 response which typically characterizes spontaneous atopic dermatitis. To our knowledge, this is the first case report in the literature discussing use of a topical JAK inhibitor, ruxolitinib, in the treatment of topical steroid-refractory cirAEs. Furthermore, as topical JAK inhibitors are thought to not carry the risks of systemic JAK inhibitors, including malignancy, ruxolitinib cream is a promising therapeutic option for this challenging patient population.
摘要：
在这份报告中,我们描述了一个在BRCA1突变背景下患有双侧乳腺癌的28岁女性的病例，出现湿疹反应的皮肤科，最终诊断为继发于免疫检查点抑制剂（ICI）的皮肤免疫相关不良事件（CirAE），帕博利珠单抗。我们的病例报告强调了湿疹性cirAE的新治疗选择：局部JAK1/2抑制剂，鲁索替尼.CirAE可发生在ICIs上的高达55％的患者中，一类药物在癌症治疗中的应用迅速增加，和先前的研究表明，ICI诱导的皮炎可能涉及与传统上观察到的不同的途径。具体来说,在ICI诱导的皮炎中注意到显著的Th1偏斜，与通常以自发性特应性皮炎为特征的主要Th2反应相反。据我们所知,这是文献中讨论使用局部JAK抑制剂的第一例病例报告，鲁索替尼,在局部类固醇难治性cirAE的治疗中。此外，因为局部JAK抑制剂被认为没有系统性JAK抑制剂的风险，包括恶性肿瘤,对于这一具有挑战性的患者群体，鲁索替尼乳膏是一种有前途的治疗选择。
