派姆单抗加重了老年患者的广泛性色素紫癜性皮肤病,一个潜在的诊断陷阱,模拟色素紫癜性皮肤病样真菌病。

IF 1.1 4区 医学 Q3 DERMATOLOGY
Nicole Chang, Yoni Hirsch, Krisztian Nemeth, Susan Pei
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引用次数: 0

摘要

靶向程序性细胞死亡蛋白1 (PD-1)、程序性细胞死亡配体1 (PD-L1)和细胞毒性淋巴细胞相关抗原4 (CTLA-4)的免疫检查点抑制剂(ICIs)已经彻底改变了癌症治疗,但与免疫相关的不良事件有关,特别是皮肤毒性。我们报告一例罕见的派姆单抗加重的色素紫癜性皮肤病(PPD)在77岁男性转移性非小细胞肺癌的历史。他的皮疹最初局限于下肢,在派姆单抗开始后恶化并广泛累及躯干。组织病理学示血管周围淋巴细胞浸润伴红细胞外渗,无血管炎,与PPD相符;然而,由于一些淋巴细胞异型性和胞外增生,加上临床广泛的病变,人们最初担心ppd样蕈样真菌病(MF)。随后的t细胞受体基因重排研究显示没有单克隆淋巴细胞群,并且PPD典型治疗后皮疹的消退不支持MF。这仅是第二例报告的ici相关PPD病例,并强调了组织病理学和临床表现模仿PPD样MF的潜在诊断缺陷。我们的病例有助于扩大ici相关皮肤反应的范围,并强调了皮肤科医生和皮肤科病理学家识别具有非典型组织病理学特征的炎症性皮肤病的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pembrolizumab-Exacerbated Widespread Pigmented Purpuric Dermatosis in an Elderly Patient, a Potential Diagnostic Pitfall Mimicking Pigmented Purpuric Dermatosis-Like Mycosis Fungoides.

Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and cytotoxic lymphocyte-associated antigen-4 (CTLA-4) have revolutionized cancer treatment but are associated with immune-related adverse events, particularly cutaneous toxicities. We report a rare case of pembrolizumab-exacerbated pigmented purpuric dermatosis (PPD) in a 77-year-old male with a history of metastatic non-small cell lung cancer. His rash, initially confined to the lower extremities, worsened and became widespread to involve the trunk after pembrolizumab initiation. Histopathology showed perivascular lymphocytic infiltrate with extravasated erythrocytes without vasculitis, compatible with PPD; however, due to some lymphocyte atypia and exocytosis, together with the clinically widespread lesions, there was initial concern for PPD-like mycosis fungoides (MF). Subsequent T-cell receptor gene rearrangement studies revealed no monoclonal lymphoid population, and the later resolution of the rash with treatments typical for PPD did not support MF. This represents only the second reported case of ICI-associated PPD and highlights a potential diagnostic pitfall with histopathology and clinical presentation mimicking PPD-like MF. Our case contributes to the expanding spectrum of ICI-related cutaneous reactions and underscores the importance of recognizing inflammatory dermatoses with atypical histopathologic features for dermatologists and dermatopathologists.

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来源期刊
CiteScore
3.20
自引率
5.90%
发文量
174
审稿时长
3-8 weeks
期刊介绍: Journal of Cutaneous Pathology publishes manuscripts broadly relevant to diseases of the skin and mucosae, with the aims of advancing scientific knowledge regarding dermatopathology and enhancing the communication between clinical practitioners and research scientists. Original scientific manuscripts on diagnostic and experimental cutaneous pathology are especially desirable. Timely, pertinent review articles also will be given high priority. Manuscripts based on light, fluorescence, and electron microscopy, histochemistry, immunology, molecular biology, and genetics, as well as allied sciences, are all welcome, provided their principal focus is on cutaneous pathology. Publication time will be kept as short as possible, ensuring that articles will be quickly available to all interested in this speciality.
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