Abstract：
Chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable success in treating various B-cell malignancies, redirecting T-cell cytotoxicity toward cancer cells. Despite its efficacy, CAR-T therapy is associated with potential risks, including cytokine release syndrome (CRS) and cytopenia. We present a case of a 69-year-old man with diffuse large B-cell lymphoma treated with axicabtagene-ciloleucel CAR-T therapy, who developed a rare and severe cutaneous toxicity resembling toxic epidermal necrolysis (TEN). The patient exhibited persistent fevers, CRS, and subsequent development of a widespread erythematous macular eruption, progressing to vesiculation with bullae. Notably, allopurinol-induced TEN was considered with the patient\'s recent exposure to allopurinol, although the onset and minimal mucosal involvement did not align with typical presentations of allopurinol-induced cases. The cutaneous reaction, distinct from typical SJS/TEN, showed minimal mucosal involvement and coincided with the cytokine release storm, differing from allopurinol-induced TEN. Despite the absence of guidelines, the patient was managed with systemic steroids, achieving significant improvement. This case expands the spectrum of CAR-T therapy-related cutaneous toxicities, highlighting the need for early recognition of histopathology and tailored management by dermatologists. Further understanding of these reactions is crucial for optimizing the safety profile of this groundbreaking immunotherapy.
摘要：
嵌合抗原受体（CAR）T细胞疗法在治疗各种B细胞恶性肿瘤方面取得了显著成功。将T细胞的细胞毒性重定向到癌细胞。尽管它的功效,CAR-T疗法与潜在风险相关，包括细胞因子释放综合征（CRS）和血细胞减少症。我们介绍了一个69岁的男性弥漫性大B细胞淋巴瘤患者的病例，该患者接受了axicabtagene-ciloleucelCAR-T治疗，他出现了一种罕见和严重的皮肤毒性，类似于中毒性表皮坏死松解症（TEN）。病人表现出持续性发烧，CRS,以及随后广泛的红斑性黄斑喷发的发展，进展到具大疱的囊泡。值得注意的是,患者最近暴露于别嘌醇时考虑了别嘌醇诱导的TEN，尽管发病和轻微的粘膜受累与别嘌醇诱导病例的典型表现不一致。皮肤反应,与典型的SJS/TEN不同，显示最小的粘膜受累，并与细胞因子释放风暴同时发生，不同于别嘌呤醇诱导的TEN。尽管没有指导方针，患者接受了全身性类固醇治疗，取得显著改善。这个病例扩大了CAR-T治疗相关皮肤毒性的范围，强调需要早期识别组织病理学和皮肤科医生的量身定制管理。进一步了解这些反应对于优化这种突破性免疫疗法的安全性至关重要。
