Management of Fatal Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrolysis (TEN) as Immune Checkpoint Inhibitor-Associated Cutaneous Toxic: Case Report and Literature Review

Huang S, Mao D, Feng L and Li W

Department of Medical Administration, Hunan Hospital of Integrated Traditional Chinese and Western Medicine, China
Department of Integrated Traditional and Western Medicine, The Second Xiangya Hospital of Central South University, China
Department of Vascular Tumor Intervention, Hunan Hospital of Integrated Traditional Chinese and Western Medicine, China
These authors contributed equally to this work

^*Correspondance to: Lei Feng 

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Abstract:

Background: Immune Checkpoint Inhibitors (ICIs) have made significant progress in anti-tumor therapy and are increasingly applied in clinical treatment. Immunotherapy-related Adverse Events (irAEs) are a major concern when ICIs are used clinically. As a severe form of skin toxicity, fatal Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) is relatively rare in clinical practice, there are no reports of SJS/TEN caused by Tirelizumab. For the treatment of SJS/TEN, various combinations of antibiotics, immunosuppressive and glucocorticoid agents are used. Case Report: We report a case of critical SJS/TEN in an adult lung squamous cell carcinoma patient who was undergoing immune checkpoint blockade with Tirelizumab, a Programmed cell Death-1 (PD-1) receptor inhibitor. The patient presented with fever, pain, anemia, rash with ulcers all over the body, myocardial injury, reduced T-lymphocytes activity and elevated IL-6 levels. Our patient was successfully treated by a multi-modality therapy regimen based on glucocorticoids. Conclusion: Our report demonstrates that severe rash is an important marker of abnormal immune status, which is followed by varying degrees of multiple organ dysfunction. Myositis is the most dangerous adverse event, closely related to the prognosis of patients. Early identification, multidepartmental consultation, and high-dose corticosteroids are the keys to successful treatment of such patients.

Keywords:

Stevens-Johnson Syndrome (SJS); Toxic Epidermal Necrolysis (TEN); Immunotherapy-related adverse events; Tirelizumab

Cite the Article:

Huang S, Mao D, Feng L, Li W. Management of Fatal Stevens- Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) as Immune Checkpoint Inhibitor-Associated Cutaneous Toxic: Case Report and Literature Review. Clin Oncol. 2024;9:2083..