Simultaneous Oral Bullous Pemphigoid and Paraneoplastic Pemphigus Following Photoimmunotherapy

Joseph D Harrington, Brandon M Locke, Robert J Diecidue
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Abstract

Head and neck cancers pose a significant challenge to clinicians to treat the disease while limiting the amount of morbidity to the patient. Given this need, new trials and medications have been explored to provide tissue sparing therapies. One of these methods being trialed at our institution is photoimmunotherapy with the PD1 inhibitor pembrolizumab. A patient with multiple recurrences of squamous cell carcinoma of the oral cavity underwent trial with photoimmunotherapy, but developed severe lip ulceration and swelling that required the patient to discontinue the trial. Biopsy and antibody testing revealed elevated levels of BP180 and BP230 indicating bullous pemphigoid. In addition, elevated Envoplakin was noted confirming a simultaneous paraneoplastic pemphigus diagnosis. Given the growing number of case reports showing an association of paraneoplastic pemphigus and bullous pemphigoid with pembrolizumab and other PD1 inhibitors, further investigation should be undertaken to better understand the incidence of these diseases with photoimmunotherapy.
光免疫疗法后同时出现口腔大疱性类天疱疮和副肿瘤性类天疱疮
头颈部癌症给临床医生带来了巨大挑战,既要治疗疾病,又要限制患者的发病率。有鉴于此,人们开始探索新的试验和药物,以提供保护组织的疗法。我们机构正在试用的其中一种方法是使用 PD1 抑制剂 pembrolizumab 的光免疫疗法。一名口腔鳞状细胞癌多次复发的患者接受了光免疫疗法试验,但出现了严重的唇部溃疡和肿胀,患者不得不中止试验。活检和抗体检测显示 BP180 和 BP230 水平升高,表明患者患有大疱性类天疱疮。此外,还发现 Envoplakin 水平升高,证实了副肿瘤性丘疹性荨麻疹的诊断。鉴于越来越多的病例报告显示副肿瘤性丘疹性荨麻疹和大疱性丘疹性荨麻疹与pembrolizumab和其他PD1抑制剂有关,因此应开展进一步调查,以更好地了解光免疫疗法在这些疾病中的发病率。
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