Abstract

TOXIC EPIDERMAL NECROLYSIS AFTER TREATMENT WITH ATEZOLIZUMAB

Theodore Tegos, Natalia Asimakopoulou, Antonios Kyriakopoulos, Edvin Vassili, Nikoletta Stavrinou, Archontoula Papadimitriou, Helen Antypa, Vassiliki Nikolaidou, Konstantina Karagiorgou, George Harkiolakis, Christina Vourlakou, Michael Vaslamatzis*

ABSTRACT

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions, and sometimes life-threatening. Many anticancer therapies seem to be responsible for developing SJS/TEN. The most common irAEs of checkpoint inhibitors are dermatologic toxicities ranging from pruritus and mild dermatoses to severe reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis. We present the case of a female patient who was diagnosed with SJS after first line treatment with immunotherapy with atezolizumab. The patient was diagnosed with an adenocarcinoma of unknown primary site, stage IV and she was treated with cisplatin, docetaxel, bevacizumab, atezolizumab. Three days after the third cycle of therapy, she was admitted to our clinic with aggravated general condition due to hypoxia, febrile neutropenia grade IV, hemodynamically unstable and with skin and mucosal ulcers (30% of body surface). She underwent skin biopsy and histogical examination was documented with a toxic epidermal necrolysis, possibly attributed to immunotherapy. The patient died after 19 days of hospitalization. Our case report draws attention to the need for including in our differential diagnosis of possible side effects of immunotherapy Stevens-Johnson syndrome.

Keywords: Toxic epidermolysis, Immunotherapy, Stevens-Johnson Syndrome, Atezolizumab.