Grover's-like drug eruption in a patient with metastatic melanoma under ipilimumab therapy. Issue 1 (16th August 2016)

• Record Type: Journal Article
• Authors: Koelzer, Viktor H.; Buser, Tobias; Willi, Niels; Rothschild, Sacha I.; Wicki, Andreas; Schiller, Peter; Cathomas, Gieri; Zippelius, Alfred; Mertz, Kirsten D.
• Is Part Of: Journal for immunotherapy of cancer. Volume 4:Issue 1(2016)
• Publication Date: 2016-08-16
• Subjects: Melanoma -- Immunotherapy -- Immune checkpoint inhibitors -- Autoimmunity -- Ipilimumab -- Grover's disease -- Transient acantholytic dermatosis -- Drug eruption; Cancer -- Immunotherapy -- Periodicals; Cancer -- Immunological aspects -- Periodicals; Tumors -- Immunological aspects -- Periodicals; Immunotherapy -- Periodicals; 616.99406105
• DOI: 10.1186/s40425-016-0151-z
• Languages: English
• ISSNs: 2051-1426

Abstract

Abstract : Background: Dermatologic toxicity is an important adverse effect of immune checkpoint inhibitors targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death 1 receptor (PD-1) or PD ligand 1 (PD-L1). Skin toxicity most commonly includes a maculopapular erythematous rash and pruritus. Rarely life threatening complications such as Steven's Johnson syndrome or toxic epidermal necrolysis may occur. Case presentation: Here we report the uncommon event of a drug-induced transient acantholytic dermatosis (Grover's disease) in a 73-year-old Caucasian male treated with ipilimumab for metastatic melanoma. Five weeks after initiation of therapy, the patient developed a widespread polymorphic papulovesicular dermatosis on the trunk and proximal extremities with intense pruritus. Skin biopsy showed acantholytic dyskeratosis with interface dermatitis consistent with a Grover's-like drug eruption. Conclusions: These findings should raise awareness for uncommon immune-related dermatological toxicities of immunomodulatory antibodies targeting the CTLA-4 signaling axis. We recommend biopsies of unexpected skin lesions to rapidly identify dermatological adverse events of immune checkpoint inhibitors.