[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-380130-105":59,"doc-detail-380130-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","immune-checkpoint-inhibitor-lichenoid-eruption-due-to-pembrolizumab-case-report","Immune checkpoint inhibitor lichenoid eruption due to pembrolizumab - Case report","","Pembrolizumab, an immune checkpoint inhibitor used across multiple cancer types, can trigger immune-related adverse events (IRAEs) with diverse clinical manifestations. This case report describes an elderly woman receiving pembrolizumab for metastatic bladder cancer who developed a cutaneous IRAE characterized by lichenoid eruptions. Symptoms responded to high-dose intravenous glucocorticoids after progression from pruritic macules to diffuse plaques and diagnostic evaluation with biopsy and cultures.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/immune-checkpoint-inhibitor-lichenoid-eruption-due-to-pembrolizumab-case-report/380130/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/immune-checkpoint-inhibitor-lichenoid-eruption-due-to-pembrolizumab-case-report/380130.png","ImageObject",300,407,{"name":92,"@type":93},"\tJames","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What treatment was associated with the lichenoid skin eruption in this case?","Question",{"text":113,"@type":114},"The patient developed the lichenoid eruption after starting pembrolizumab for metastatic bladder cancer.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the rash progress before hospital admission?",{"text":118,"@type":114},"The rash progressed over about two weeks from scattered pruritic macules to diffuse plaques covering all extremities despite topical therapy, antihistamines, and holding pembrolizumab.",{"name":120,"@type":111,"acceptedAnswer":121},"What diagnostic approach was used to evaluate the eruption?",{"text":122,"@type":114},"Multiple skin biopsies were obtained for pathology, including perilesional direct immunofluorescence, along with tissue culture and serologic testing for related immunobullous causes.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},380130,1790763808,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52},2336474466412,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Case report  \nImmune checkpoint inhibitor lichenoid eruption due to pembrolizumab  \nBenjamin Joseph McCormick  , 1 Daniel Zieman,2 Cassidy West-Santos,3 Michael B Phillips  1  \n1Internal Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA  \n2Dermatology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA 3Anesthesiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA  \nCorrespondence to  \nDr Benjamin Joseph McCormick; [mccormick.benjamin@mayo.edu](mccormick.benjamin@mayo.edu)  \nAccepted 6 June 2023  \n© BMJ Publishing Group Limited 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.  \nTo cite: McCormick BJ, Zieman D, West-Santos C, et al. BMJ Case Rep 2023;16:e254692 . doi:10 . 1136/bcr-2023- 254692  \nSUMMARY  \nPembrolizumab is an immune checkpoint inhibitor used in many cancer types, including genitourinary cancers. Although immunotherapies have dramatically changed the landscape of cancer treatment by providing an alternative to traditional chemotherapy, they have been associated with significant immune-related adverse events (IRAEs) with wide-ranging clinical manifestations. We present the case of an elderly woman on pembrolizumab for metastatic bladder cancer who developed cutaneous IRAE with lichenoid eruptions that responded to high-dose intravenous glucocorticoids.  \nBACKGROUND  \nImmune checkpoint inhibitor (ICI) therapies have dramatically changed the landscape of cancer treatment by providing an alternative to chemotherapy. However, ICI therapies, such as pembrolizumab, are associated with significant immune-related adverse events (IRAEs) affecting all organ systems. Cutaneous manifestations are common with clinical presentations including maculopapular rash, psoriasiform rash, bullous dermatitis, lichenoid eruption, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). ICI lichenoid eruptions present later than maculopapular and psoriasiform rashes, most commonly 6–12 weeks after initiation of immunotherapy.1 Lichenoid eruptions have been reported in 0.5%–6% of patients treated with anti-PD-1/PD-L1 immunotherapies.2 Systemic glucocorticoids are the mainstay of therapy formost high-grade IRAEs. High-potency topical steroids can be considered for grade 1 ICI bullous dermatitis—when the disease involves \u003C10% body surface area (BSA)—but for grades 2–4, systemic corticosteroids are recommended.3–5 However, the current National Comprehensive Cancer Network (NCCN) guidelines do not address management recommendations for ICI lichenoid eruptions.  \nCASE PRESENTATION  \nA woman in her 80s presented to the emergency department for a diffuse, progressive rash with pruritus. She had active metastatic bladder cancer and developed a rash 92 days after the initiation of immunotherapy with pembrolizumab. Two weeks before admission, the patient’s skin lesions evolved from scattered pruritic macules to diffuse plaques covering all extremities, despite conservative management with topical triamcinolone, oral antihistamines and holding pembrolizumab. She denied  \nconstitutional symptoms, abdominal pain, nausea, vomiting, dyspnoea or chest pain.  \nOn admission, she was afebrile and normotensive with a pulse rate of 74 beats per minute and SpO2 of 95% on room air. A physical examination of the patient revealed cachexia, mild oropharyngeal mucositis, angular cheilitis and a right subclavian port without surrounding erythema or purulence. A focused dermatological examination was significant for diffuse violaceous plaques and erosions with adherent haemorrhagic crusting on her face, bilateral upper and lower extremities, and dorsal surfaces of her hands (figure 1). Multiple lesions on the upper and lower extremities exhibited purulence. The left lower extremity also had erosions with a negative Nikolsky sign. There were no targetoid or dusky lesions, facial swelling, conjunctivitis or lymphadenopathy. The patient’s laboratory findings were notab","cbCaicMGG6VRvsFO","https://ap.wps.com/l/cbCaicMGG6VRvsFO","pdf",1084710,"English","# Summary\n# Background\n# Case presentation\n## Patient symptoms and clinical findings\n# Investigations\n## Biopsy and laboratory results\n# Differential diagnosis","[{\"question\":\"What treatment was associated with the lichenoid skin eruption in this case?\",\"answer\":\"The patient developed the lichenoid eruption after starting pembrolizumab for metastatic bladder cancer.\"},{\"question\":\"How did the rash progress before hospital admission?\",\"answer\":\"The rash progressed over about two weeks from scattered pruritic macules to diffuse plaques covering all extremities despite topical therapy, antihistamines, and holding pembrolizumab.\"},{\"question\":\"What diagnostic approach was used to evaluate the eruption?\",\"answer\":\" Multiple skin biopsies were obtained for pathology, including perilesional direct immunofluorescence, along with tissue culture and serologic testing for related immunobullous causes.\"}]","Immune checkpoint inhibitor lichenoid eruption due to pembrolizumab - Case report | PDF",1790238866]