Neutrophil-predominant bullous pemphigoid induced by checkpoint inhibitors: A case series

J Cutan Pathol. 2020 Aug;47(8):742-746. doi: 10.1111/cup.13687. Epub 2020 Apr 29.

Abstract

Checkpoint inhibitors have been revolutionary in the treatment of metastatic melanoma, non-small-cell lung cancer, and renal cell carcinoma. By restricting negative feedback of T-cells, checkpoint inhibitors allow the immune system to identify and destroy malignant cells. This enhanced immune response is efficacious in the treatment of the aforementioned malignancies; however, it may lead to immune-related adverse events. Bullous pemphigoid (BP) is a well-documented cutaneous adverse reaction of checkpoint inhibitors, with a majority of cases reporting an eosinophil-predominant or mixed inflammatory infiltrate. We report two cases of neutrophil-predominant BP presenting in patients on checkpoint inhibitors.

Keywords: bullous pemphigoid; immune checkpoint inhibitors; immune-related adverse events; neutrophil.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antimalarials / administration & dosage
  • Antimalarials / therapeutic use
  • Dapsone / administration & dosage
  • Dapsone / therapeutic use
  • Drug Eruptions / pathology
  • Drug Therapy, Combination
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects*
  • Immune Checkpoint Inhibitors / therapeutic use
  • Lung Neoplasms / secondary
  • Male
  • Melanoma / drug therapy*
  • Melanoma / pathology
  • Neutrophils / pathology*
  • Pemphigoid, Bullous / chemically induced*
  • Pemphigoid, Bullous / drug therapy
  • Pemphigoid, Bullous / metabolism
  • Pemphigoid, Bullous / pathology*
  • Prednisone / administration & dosage
  • Prednisone / therapeutic use
  • Skin / pathology*
  • Treatment Outcome

Substances

  • Antimalarials
  • Glucocorticoids
  • Immune Checkpoint Inhibitors
  • Dapsone
  • Prednisone