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Year : 2018  |  Volume : 1  |  Issue : 2  |  Page : 78-81

Toxic epidermal necrolysis during cotherapy with ipilimumab and nivolumab

1 McGovern Medical School at UTHealth at Houston, Texas, USA
2 University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Correspondence Address:
Dr. Anisha B Patel
1515 Holcombe Blvd, FCT 11.5000, Unit 1452, Houston, Texas
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Source of Support: None, Conflict of Interest: None

DOI: DOI: 10.4103/JIPO.JIPO_7_18

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Ipilimumab and nivolumab are human monoclonal antibodies used in cancer therapy. Ipilimumab targets cytotoxic T-lymphocyte-associated antigen and nivolumab acts against programmed death receptor-1. Both drugs have extensive side effect profiles with high rates of cutaneous involvement. We present a 57-year-old male with stage IV esophageal/gastroesophageal junction adenocarcinoma that developed histologically confirmed toxic epidermal necrolysis (TEN) 6 days after cotreatment with ipilimumab and nivolumab. He presented with diffuse erythematous macules with confluence and large flaccid bullae with scrotal and mucosal involvement. He improved significantly following drug cessation, steroids, and antibiotics. TEN has been reported with ipilimumab and/or nivolumab, as have other severe drug reactions including Stevens–Johnson syndrome and erythema multiforme major. As a true dermatologic emergency, TEN should be recognized as a potential complication of ipilimumab, nivolumab, and other immune checkpoint inhibitors, so clinicians can quickly recognize the condition and initiate therapy.

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