title: Unexpected recalcitrant course of drug-induced erythema multiforme-like eruption and interstitial pneumonia sequentially occurring after nivolumab therapy.
abstract: Vemurafenib improves survival of melanoma patients. However, cutaneous side-effects commonly occur in them. Nivolumab and ipilimumab are monoclonal antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4, both of which regulate excessive T-cell activation. Although these agents induce antitumor immunity against melanoma, the modified immune condition may result in an unexpected adverse reaction which has not been observed previously. Herein, we report a case who manifested severe erythema multiforme-like eruption with mucosal involvement associated with vemurafenib following nivolumab. The patient also subsequently suffered from ipilimumab-induced interstitial pneumonia with refractory course. Such a case has never been reported. This case suggested that dermatologists should pay special attention to unexpected adverse events of these drugs, and carefully observe cutaneous and respiratory status of patients during the treatment of melanoma.
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nomura
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Satsuki
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kurihara
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Chubachi
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawada
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Betsuyaku
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Amagai
authors.affiliation: Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Funakoshi
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D001706:Biopsy; D060908:CTLA-4 Antigen / Q000037:antagonists & inhibitors; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology; D004351:Drug Resistance; D004892:Erythema Multiforme / Q000139:chemically induced / Q000175:diagnosis*; D005334:Fever / Q000139:chemically induced; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D000074324:Ipilimumab; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D000077594:Nivolumab; D010307:Parotid Neoplasms / Q000188:drug therapy / Q000556:secondary; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors / Q000235:genetics; D020551:Pulse Therapy, Drug; D012878:Skin Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D013449:Sulfonamides / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D000077484:Vemurafenib; D028761:Withholding Treatment
chemical_list: D000911:Antibodies, Monoclonal; D000074322:Antineoplastic Agents, Immunological; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D005938:Glucocorticoids; D007211:Indoles; D000074324:Ipilimumab; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; D013449:Sulfonamides; D000077484:Vemurafenib; D000077594:Nivolumab; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: erythema multiforme; interstitial pneumonia; ipilimumab; nivolumab; vemurafenib