Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report
Ziyu Jiang,1,2,* Xiaoli Chen,2,3,* Zhaoshen Sun,2,4 Xiaowei Shen,2,3 Yaju Huang,2,3 Jingbing Liu1,2 1Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China...
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Dove Medical Press
2023-11-01
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| Series: | Journal of Inflammation Research |
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| Online Access: | https://www.dovepress.com/toxic-epidermal-necrolysis-and-stevens---johnson-syndrome-following-si-peer-reviewed-fulltext-article-JIR |
| _version_ | 1797640515116597248 |
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| author | Jiang Z Chen X Sun Z Shen X Huang Y Liu J |
| author_facet | Jiang Z Chen X Sun Z Shen X Huang Y Liu J |
| author_sort | Jiang Z |
| collection | DOAJ |
| description | Ziyu Jiang,1,2,* Xiaoli Chen,2,3,* Zhaoshen Sun,2,4 Xiaowei Shen,2,3 Yaju Huang,2,3 Jingbing Liu1,2 1Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China; 2Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China; 4Department of Dermatology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingbing Liu; Yaju Huang, Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China, Tel +86 025 85637121 ; +86 025 85639241, Email ljb0427@sina.com; huangyaju1113@163.comAbstract: Immune checkpoint inhibitors such as monoclonal antibodies have been used recently with greater effect for the management of non-small cell lung cancer (NSCLC). Sintilimab, a fully human IgG4 monoclonal antibody is specific for the immune checkpoint protein programmed cell death receptor-1 (PD-1). It is a common medication adopted for treating Hodgkin’s lymphoma and NSCLC. The adverse effects associated with the use of monoclonal antibodies should be closely monitored and in the current report, the use of sintilimab for treating NSCLC led to skin-associated adverse effects such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Genetic testing showed that genes such as KRAS, CREBBP, NTRK1, RAF1, and TP53 were mutated. Initial visible symptom included the formation of a vesicular rash on the skin that had spread to the upper limbs, chest, and dorsum 1 week after the administration of sintilimab. The patient received anti-inflammatory agents to prevent worsening of the rashes and further infections. When the vesicles in back and limbs enlarged and the neck skin began to desquamate, the patient was diagnosed with Stevens-Johnson syndrome and sintilimab-induced toxic epidermal necrolysis. Toxic epidermal necrolysis was diagnosed via clinical symptoms and physical examination. The patient also reported the symptoms of oral mucositis. As soon as the dose of sintilimab was reduced to 20 mg/day, the skin-associated condition of the patient began to improve. Although the lump in the lungs decreased considerably 45 days after initial administration of sintilimab, the medication was stopped from use as soon as the skin-related symptoms improved after its withdrawal. This report suggests that close monitoring, personal care, and proper use of medications such as sintilimab should be implemented to avoid such rare skin-associated toxicities as an adverse effect.Keywords: sintilimab, checkpoint inhibitor, monoclonal antibody, NSCLC, adverse effects |
| first_indexed | 2024-03-11T13:32:02Z |
| format | Article |
| id | doaj.art-f5844a431427442392d05210ec425563 |
| institution | Directory Open Access Journal |
| issn | 1178-7031 |
| language | English |
| last_indexed | 2024-03-11T13:32:02Z |
| publishDate | 2023-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Inflammation Research |
| spelling | doaj.art-f5844a431427442392d05210ec4255632023-11-02T17:13:57ZengDove Medical PressJournal of Inflammation Research1178-70312023-11-01Volume 165061506787835Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case ReportJiang ZChen XSun ZShen XHuang YLiu JZiyu Jiang,1,2,* Xiaoli Chen,2,3,* Zhaoshen Sun,2,4 Xiaowei Shen,2,3 Yaju Huang,2,3 Jingbing Liu1,2 1Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China; 2Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China; 4Department of Dermatology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingbing Liu; Yaju Huang, Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, People’s Republic of China, Tel +86 025 85637121 ; +86 025 85639241, Email ljb0427@sina.com; huangyaju1113@163.comAbstract: Immune checkpoint inhibitors such as monoclonal antibodies have been used recently with greater effect for the management of non-small cell lung cancer (NSCLC). Sintilimab, a fully human IgG4 monoclonal antibody is specific for the immune checkpoint protein programmed cell death receptor-1 (PD-1). It is a common medication adopted for treating Hodgkin’s lymphoma and NSCLC. The adverse effects associated with the use of monoclonal antibodies should be closely monitored and in the current report, the use of sintilimab for treating NSCLC led to skin-associated adverse effects such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Genetic testing showed that genes such as KRAS, CREBBP, NTRK1, RAF1, and TP53 were mutated. Initial visible symptom included the formation of a vesicular rash on the skin that had spread to the upper limbs, chest, and dorsum 1 week after the administration of sintilimab. The patient received anti-inflammatory agents to prevent worsening of the rashes and further infections. When the vesicles in back and limbs enlarged and the neck skin began to desquamate, the patient was diagnosed with Stevens-Johnson syndrome and sintilimab-induced toxic epidermal necrolysis. Toxic epidermal necrolysis was diagnosed via clinical symptoms and physical examination. The patient also reported the symptoms of oral mucositis. As soon as the dose of sintilimab was reduced to 20 mg/day, the skin-associated condition of the patient began to improve. Although the lump in the lungs decreased considerably 45 days after initial administration of sintilimab, the medication was stopped from use as soon as the skin-related symptoms improved after its withdrawal. This report suggests that close monitoring, personal care, and proper use of medications such as sintilimab should be implemented to avoid such rare skin-associated toxicities as an adverse effect.Keywords: sintilimab, checkpoint inhibitor, monoclonal antibody, NSCLC, adverse effectshttps://www.dovepress.com/toxic-epidermal-necrolysis-and-stevens---johnson-syndrome-following-si-peer-reviewed-fulltext-article-JIRsintilimabcheckpoint inhibitormonoclonal antibodynsclcadverse effects. |
| spellingShingle | Jiang Z Chen X Sun Z Shen X Huang Y Liu J Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report Journal of Inflammation Research sintilimab checkpoint inhibitor monoclonal antibody nsclc adverse effects. |
| title | Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report |
| title_full | Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report |
| title_fullStr | Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report |
| title_full_unstemmed | Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report |
| title_short | Toxic Epidermal Necrolysis and Stevens - Johnson Syndrome Following Sintilimab Administration in a Non-Small Cell Lung Cancer Patient: A Case Report |
| title_sort | toxic epidermal necrolysis and stevens johnson syndrome following sintilimab administration in a non small cell lung cancer patient a case report |
| topic | sintilimab checkpoint inhibitor monoclonal antibody nsclc adverse effects. |
| url | https://www.dovepress.com/toxic-epidermal-necrolysis-and-stevens---johnson-syndrome-following-si-peer-reviewed-fulltext-article-JIR |
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