A case of bullous pemphigoid in the oral cavity after treatment with nivolumab

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  • NISHIO Yoshitomo
    Department of Oral and Maxillofacial Surgery, Aichi Medical University
  • FURUHASHI Akifumi
    Department of Oral and Maxillofacial Surgery, Aichi Medical University
  • HAYASHI Tomio
    Department of Oral and Maxillofacial Surgery, Aichi Medical University
  • ITO Kunihiro
    Department of Oral and Maxillofacial Surgery, Aichi Medical University
  • ONO Takayuki
    Department of Oral and Maxillofacial Surgery, Aichi Medical University
  • KAZAOKA Yoshiaki
    Department of Oral and Maxillofacial Surgery, Aichi Medical University

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Other Title
  • ニボルマブ投与後に水疱性類天疱瘡が口腔粘膜に生じた1例
  • ニボルマブ トウヨ ゴ ニ スイホウセイルイ テンポウソウ ガ コウコウ ネンマク ニ ショウジタ 1レイ

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<p>Nivolumab, a human IgG4 PD-1 immune checkpoint inhibitor antibody, was approved in Japan for malignant melanoma in 2014, and its indications have been expanded to lung as well as head and neck cancer. However, various immune-related adverse events (irAE) have been reported, and pemphigoid was added to irAE in April 2018. To our knowledge, only four cases of oral bullous pemphigoid have been reported to date. Here, we report a case of bullous pemphigoid in a 64-year-old woman with gingival pain who was successfully treated with nivolumab for renal cancer. After the administration of nivolumab for renal carcinoma, edematous erythema and tense bullae on the palms and dorsum of the feet were observed, however biopsy revealed drug-induced lichen planus, which improved with application of topical steroids. One year after nivolumab administration, the lesions disappeared and the renal cancer treatment was completed. At three months after the end of administration of nivolumab, she experienced gingival redness, erosions, and pain; at this time she was under observation in the urology department. At five months, she was referred to our department for exacerbated gingival pain. Bullous pemphigoid was diagnosed based on a biopsy and ELISA that revealed anti-BP180 antibodies. The prognosis was good; the remission of bullous pemphigoid was obtained with prednisolone, and no recurrence of renal cancer was noted. Appropriate management of irAE during and after administration of immune checkpoint inhibitors is expected to improve the outcome of cancer treatment.</p>

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