1
|
Hetzel JD, Diamond DC, Ramsey ZC, Henson JW, Powell MR. Postherpetic granulomatous dermatitis occurring in the setting of immune checkpoint inhibitor therapy: A case report. J Cutan Pathol 2024; 51:30-33. [PMID: 37589212 DOI: 10.1111/cup.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/21/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
We report a case of a 72-year-old man presenting with a 2-month history of a persistent, painful rash of the chest, axilla, and back. He had a history of recently resolved varicella zoster virus reactivation in the same distribution of the current rash and metastatic malignant melanoma treated with nivolumab and ipilimumab. The histopathology was consistent with granulomatous dermatitis (GD), and a diagnosis of postherpetic isotopic response manifesting as GD was made. Given the paucity of reported cases of postherpetic GD in the setting of treatment with immune checkpoint inhibitors (ICIs), we discuss the clinicopathologic features of this case and potential mechanisms by which ICIs may contribute to the development of granulomatous disease.
Collapse
Affiliation(s)
- John D Hetzel
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Davis C Diamond
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Zachary C Ramsey
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - John W Henson
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
- Heme/Onc Division, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Matthew R Powell
- Department of Dermatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
- Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| |
Collapse
|
2
|
Martel J, Hanania HL, Patel AB. Immune checkpoint inhibitor-induced cutaneous toxicities: a review of histopathologic and clinical features. Hum Pathol 2023; 140:144-172. [PMID: 37141978 DOI: 10.1016/j.humpath.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) represent an emerging treatment option for a variety of cancer types. Through inhibition of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and/or cytotoxic lymphocyte-associated antigen-4 (CTLA-4), ICIs activate the host's immune system causing a heightened anti-tumor response. However, off-target effects of ICIs can result in numerous different immune-related cutaneous adverse events (irCAEs). Beyond impacting quality of life, irCAEs can lead to dose limitations or discontinuation of anti-cancer therapies. Correct diagnosis is necessary for expedient and appropriate management. Skin biopsies are often performed to increase diagnostic accuracy and guide clinical management. An extensive literature review was performed using the PubMed database to identify the reported clinical and histopathologic features of irCAEs. This comprehensive review primarily details the histopathologic features of various irCAEs reported to date. Clinical presentation and immunopathogenesis are also discussed in relation to histopathology.
Collapse
Affiliation(s)
- Julianna Martel
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Anisha B Patel
- Department of Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA.
| |
Collapse
|
3
|
Mital R, Cartron AM, Trinidad JC, Spaccarelli N, Gibbons-Fideler IS, Kaffenberger BH, Chung CG. Novel cutaneous eruptions in the setting of programmed cell death protein 1 inhibitor therapy. JAAD Case Rep 2022; 31:124-127. [PMID: 36583144 PMCID: PMC9792734 DOI: 10.1016/j.jdcr.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rohan Mital
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexander M. Cartron
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John C. Trinidad
- Department of Dermatology, Massachusetts General Hospital, Cambridge, Massachusetts
| | - Natalie Spaccarelli
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Catherine G. Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio,Correspondence to: Catherine G. Chung, MD, 2050 Kenny Rd MMT 930, Columbus, OH 43221.
| |
Collapse
|
4
|
Tripathy DM, Kumar S, Saraswat N, Goel S, Ranjan E. Post herpetic granulomatous dermatitis and herpes zoster necroticans triggered by Covid-19 vaccination. Dermatol Ther 2022; 35:e15707. [PMID: 35811450 PMCID: PMC9350396 DOI: 10.1111/dth.15707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/18/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sushil Kumar
- Dermatology, Motilal Nehru Medical College, Allahabad, India
| | | | | | | |
Collapse
|
5
|
Tsang DA, Tang PY, Oh CC. Dermatoscopic features of acute granulomatous ulceronecrotic herpes zoster of the face. JAAD Case Rep 2022; 25:107-110. [PMID: 35799685 PMCID: PMC9253830 DOI: 10.1016/j.jdcr.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Denise A Tsang
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Po Y Tang
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Choon C Oh
- Department of Dermatology, Singapore General Hospital, Singapore
| |
Collapse
|
6
|
Serra F, Cassaniti I, Lilleri D, Pedrazzoli P, Baldanti F, Lasagna A. Herpes zoster in patients with solid tumors treated with immune checkpoint inhibitors. Immunotherapy 2022; 14:389-393. [DOI: 10.2217/imt-2021-0333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tweetable abstract Herpes zoster (HZ) is a vaccine-preventable disease, but the role of the vaccine in cancer patients during immunotherapy (ICIs) is still unknown. The clinical and economic consequences of HZ and the increased use of ICIs require a greater awareness by the oncologist.
Collapse
Affiliation(s)
- Francesco Serra
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
- Dept. of Internal Medicine & Medical Therapy, University of Pavia, Pavia, 27100, Italy
| | - Irene Cassaniti
- Molecular Virology Unit, Dept. of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Daniele Lilleri
- Molecular Virology Unit, Dept. of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
- Dept. of Internal Medicine & Medical Therapy, University of Pavia, Pavia, 27100, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Dept. of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
- Dept. of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, Pavia, 27100, Italy
| | - Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| |
Collapse
|
7
|
Chadha SA, Zheng L, Sunshine JC, Guggina LM, Nguyen CV. Postherpes zoster programmed death-1 inhibitor−associated zosteriform granulomatous reactions. JAAD Case Rep 2020; 6:1201-1204. [PMID: 33294541 PMCID: PMC7695814 DOI: 10.1016/j.jdcr.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Simran A. Chadha
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lida Zheng
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel C. Sunshine
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren M. Guggina
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cuong V. Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Correspondence to: Cuong V. Nguyen, MD, 676 N Saint Clair St, Suite 1725, Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
8
|
Gozzi E, Rossi L, Angelini F, Leoni V, Trenta P, Cimino G, Tomao S. Herpes zoster granulomatous dermatitis in metastatic lung cancer treated with nivolumab: A case report. Thorac Cancer 2020; 11:1330-1333. [PMID: 32141197 PMCID: PMC7180604 DOI: 10.1111/1759-7714.13377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 11/28/2022] Open
Abstract
Granulomatous dermatitis (GD) is the most common among a variety of skin reactions that may occur in the varicella‐zoster virus (VZV) reactivation area. It is thought that the formation of granulomas may be the result of a delayed hypersensitivity reaction to viral envelope glycoproteins. Immune checkpoint inhibitors (ICIs), such as nivolumab stimulate T cells and promote hypersensitivity reactions, leading to the formation of granulomas in VZV wrapping proteins, thus triggering VZV‐GD. Few cases of the use of ICIs in patients diagnosed with VZV‐GD have been reported in the literature. Here, we report the clinical case of a patient with metastatic lung cancer which was treated with nivolumab who subsequently developed VZV‐GD. Accurate clinical diagnosis and prompt treatment with antiviral agents have resulted in a complete resolution of the clinical picture. Key points What this study adds Few cases of ICI and VZV reactivation have been reported in the literature. Full and timely resolution of VZV‐GD allowed the continuation of ICI treatment.
Collapse
Affiliation(s)
- Elisa Gozzi
- UOC of Oncology - ASL Latina- Distretto 1, University of Rome "Sapienza," via Giustiniano snc - 04011, Aprilia, Italy
| | - Luigi Rossi
- UOC of Oncology - ASL Latina- Distretto 1, University of Rome "Sapienza," via Giustiniano snc - 04011, Aprilia, Italy
| | | | - Valentina Leoni
- Medical Oncology Unit, Regina Apostolorum Hospital, Rome, Italy
| | - Patrizia Trenta
- Medical Oncology Unit, Regina Apostolorum Hospital, Rome, Italy
| | - Giuseppe Cimino
- Department of Medical Oncology, Sapienza University of Rome, Medical and Surgical Sciences and Biotechnology, Rome, Italy
| | - Silverio Tomao
- Division of Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Consorzio Interuniversitario per la Bio-Oncologia (CINBO), Chieti, Italy
| |
Collapse
|
9
|
Kubicki SL, Welborn ME, Garg N, Aung PP, Patel AB. Granulomatous dermatitis associated with ipilimumab therapy (ipilimumab associated granulomatous dermatitis). J Cutan Pathol 2018; 45:636-638. [PMID: 29704281 DOI: 10.1111/cup.13267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Shelby L Kubicki
- Department of Dermatology, McGovern Medical School at UTHealth at Houston, Houston, Texas
| | - Macartney E Welborn
- Department of Dermatology, McGovern Medical School at UTHealth at Houston, Houston, Texas
| | - Naveen Garg
- Department of Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, Texas
| | - Phyu P Aung
- Department of Pathology, UT MD Anderson Cancer Center, Houston, Texas
| | - Anisha B Patel
- Department of Dermatology, McGovern Medical School at UTHealth at Houston, Houston, Texas.,Department of Dermatology, UT MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
10
|
Diaz-Perez JA, Beveridge MG, Victor TA, Cibull TL. Granulomatous and lichenoid dermatitis after IgG4 anti-PD-1 monoclonal antibody therapy for advanced cancer. J Cutan Pathol 2018; 45:434-438. [PMID: 29468713 DOI: 10.1111/cup.13133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/10/2018] [Accepted: 02/16/2018] [Indexed: 01/14/2023]
Abstract
Nivolumab is a fully human IgG4 monoclonal antibody directed against programmed cell death protein 1 (PD-1). PD-1 inhibition allows T-cell activation and recruitment to destroy cancer cells. Checkpoint inhibitors have shown significant survival advantage and relatively low side-effects in comparison with conventional chemotherapy in several types of advanced cancer. Granulomatous cutaneous reactions have been reported showing sarcoidal and panniculitic morphology. Here we present a case of drug-induced lichenoid and granulomatous dermatitis after checkpoint inhibitor therapy observed in a 63-year-old male treated with nivolumab for advanced glioblastoma. This morphology has not been previously reported. We documented a high number of CD8+ T-cells within the lesions. Additionally, we review the side-effects observed with the use of checkpoint inhibitors, with special focus on cutaneous manifestations.
Collapse
Affiliation(s)
- Julio A Diaz-Perez
- Department of Pathology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Mara G Beveridge
- Department of Dermatology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Thomas A Victor
- Department of Pathology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| | - Thomas L Cibull
- Department of Pathology, NorthShore University Health System, University of Chicago, Evanston, Illinois
| |
Collapse
|