帕博利珠单抗致中毒性表皮坏死松解症1例

A case of toxic epidermal necrolysis caused by pembrolizumab

1例72岁男性右肺鳞癌患者行帕博利珠单抗联合化疗治疗1个疗程后,予帕博利珠单抗200 mg单药治疗。用药20 d后,患者口周、头颈和胸背部出现少量红斑,伴瘙痒,后皮损进行性加重,扩散至头部、四肢、臀部与肛周,并出现水疱及表皮脱落坏死,皮损累及>70%体表面积,疼痛明显。经多学科会诊后考虑为中毒性表皮坏死松解症(TEN)。经激素、静脉注射用免疫球蛋白辅助治疗,创面护理,感染预防和营养支持等治疗后,患者皮损逐渐好转。经评估,患者TEN不良反应与帕博利珠单抗的关联性为很可能有关。本文报道帕博利珠单抗致TEN的病例,分析帕博利珠单抗致TEN的临床特点及药物治疗策略,以期提高临床医护人员对免疫抑制剂相关皮肤毒性的识别与管理能力,改善肿瘤患者预后。

A 72-year-old male patient with right lung squamous cell carcinoma treated with 1 cycle of pembrolizumab combination chemotherapy and pembrolizumab 200 mg monotherapy.After 20 days of treatment,a small amount of erythema appeared around the mouth,head,neck,chest and back,accompanied by itching.Then the lesions aggravated progressively,spreading to the head,limbs,buttocks and perianal area,with blisters and epidermal detachment and necrosis,and the lesions involved>70%of the body surface area,and the pain was obvious.After multidisciplinary consultation,toxic epidermal necrolysis(TEN)was considered.The patient's lesions gradually improved and regressed after treatment with hormones,adjunctive therapy with intravenous immunoglobulin,wound care,infection prevention and nutritional support.TEN adverse reactions were highly likely to be associated with pembrolizumab.This paper reviewed the literature on the cases of TEN induced by pembrolizumab.It analyzed the clinical characteristics and drug treatment strategies of TEN induced by pembrolizumab,to improve clinical staff's ability to recognize and manage immunosuppressant-related skin toxicity and improve the prognosis of tumor patients.