title: Severe bullous pemphigoid associated with pembrolizumab therapy for metastatic melanoma with complete regression.
abstract: Bullous pemphigoid (BP) is considered to be a humorally mediated autoimmune disease, but autoreactive T-cells and T-regulatory cells (Tregs) have also been implicated in this disease. Tregs and the programmed death-1 (PD-1) : programmed death ligand (PD-L) pathway are both critical in terminating immune response, and elimination of either can result in breakdown of tolerance and development of autoimmunity. We report a patient with metastatic malignant melanoma (MM), who underwent pembrolizumab (anti-PD-1) therapy following unsuccessful treatment with ipilimumab [anti-cytotoxic T-lymphocyte-associated protein (CTLA)-4]. The patient developed BP with increasing serum titres of anti-BP180 IgG autoantibodies and increasing disease severity during pembrolizumab therapy. High doses of corticosteroids and methotrexate were needed to control the BP. Following the termination of pembrolizumab therapy, imaging showed complete regression of all metastatic sites. This result may indicate a crucial role for T-cell suppressive activity in controlling and preventing BP.
authors.affiliation: Department of Dermatology, Rambam Health Care Campus, Technion, Institute of Technology, Haifa, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Rofe
authors.affiliation: Department of Oncology, Rambam Health Care Campus, Technion, Institute of Technology, Haifa, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Bar-Sela
authors.affiliation: Department of Nuclear Medicine, Rambam Health Care Campus, Technion, Institute of Technology, Haifa, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Keidar
authors.affiliation: Department of Dermatology, Allergy and Venereology, University of Lubeck, Lubeck, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Sezin
authors.affiliation: Department of Dermatology, Allergy and Venereology, University of Lubeck, Lubeck, Germany.
authors.forename: C D
authors.initials: CD
authors.lastname: Sadik
authors.affiliation: Department of Dermatology, Rambam Health Care Campus, Technion, Institute of Technology, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Bergman
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000139:chemically induced* / Q000188:drug therapy / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000556:secondary
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; C582435:pembrolizumab