A Case of Lichenoid Eruption with Central Necrosis Appearing during Administration of Pembrolizumab

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  • ペムブロリズマブ投与中に中心壊死を伴う苔癬様皮疹を発症した 1 例

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<p>A 77-year-old woman, who had been treated with pembrolizumab for lung adenocarcinoma,developed erythematous papules with mild itching on her limbs during the 24th course of immunotherapy. Her skin lesions gradually expanded and she was referred to us a month after the onset. Due to the progression of the primary and metastatic lesions of lung cancer, pembrolizumab was discontinued. At the first visit, hyperkeratotic erythematous lesions, some with central crusting, were observed mainly on her distal extremities. Histopathological examination demonstrated epidermal necrosis at the center of the lesion. Many dyskeratotic cells and mononuclear cell infiltration, which consists chiefly of CD8positive lymphocytes, were observed in the epidermis, with vacuolar alteration of the basal layer. Although we considered the cutaneous manifestations to be a lichenoid eruption, topical steroid therapy failed. Our reconsideration of clinical and histopathological findings of extensive necrosis together with numerous dyskeratotic cells in the epidermis led to a diagnosis of close pathophysiological resemblance to pityriasis lichenoides et varioliformis acuta (PLEVA). Subsequent oral administration of macrolide antibiotics based on this diagnosis improved the cutaneous lesions. There have been no reports of lichen planus or PLEVA-like eruption caused by lung cancer. In this case, neither infectious disease nor a drug evoking drug allergy was found. This suggested that pembrolizumab caused the rash. Therefore, this case was considered an immune-related adverse event of anti-PD-1 therapy. As PD 1 blockade can often cause lichenoid eruption, which exhibits differing degrees of clinical and histopathological changes, we diagnosed the patient with lichenoid eruption. Skin Research, 20 :332-337, 2021 </p>

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  • Hifu no kagaku

    Hifu no kagaku 20 (4), 332-337, 2021

    Meeting of Osaka Dermatological Association/Meeting of Keiji Dermatological Association

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