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Case Reports
. 2020 May;9(5):3776-3782.
doi: 10.21037/tcr.2020.03.57.

Atezolizumab-induced psoriasis in a patient with metastatic lung cancer-a case report

Mian Mao  1 , Min Shi  2 , Tao Li  3 , Qifeng Wang  3 , Lei Wu  3
Affiliations
Case Reports

Atezolizumab-induced psoriasis in a patient with metastatic lung cancer-a case report

Mian Mao et al. Transl Cancer Res. 2020 May.

Abstract

Immune checkpoint inhibitors, now FDA-approved, are being increasingly used for diverse cancer types. Dermatological complications are most frequent immune-related adverse events during immune checkpoints inhibitors therapies. There is no case reporting psoriasis exacerbation from Asia until now. We present a case of a 53-year-old Chinese man with non-small cell lung cancer (NSCLC) who presented with severe psoriasis at about two weeks after atezolizumab initiation. A skin punch biopsy was performed which revealed these were hyperkeratosis with IL-17A expression positive and confirmed the diagnosis of psoriasis. Atezolizumab was discontinued. Psoriasis was treated with flumethasone ointment every 12 hours and desloratadine 5 mg once daily for 2 weeks instead of phototherapies and improved completely over the next 2 months. He received chemotherapy in 4 cycles and radiotherapy and remained stable disease until December, 2019. Oncologists should pay attention to potential psoriasis exacerbation when patients use anti-programmed death ligand 1 (anti-PD-L1), especially who had a personal psoriasis-related history.

Keywords: Atezolizumab; anti-programmed death ligand 1 (anti-PD-L1); case report; non-small cell lung cancer (NSCLC); psoriasis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2020.03.57). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Severe psoriasis flare after the first dose of programmed death-ligand 1 inhibitor (atezolizumab) therapy. Severe psoriatic plaques on the head (A) and limbs (B), guttate lesions on the trunk (C,D).
Figure 2
Figure 2
Skin biopsy with hyperkeratosis with minimal immunoinfiltrates noted. Left-H&E: original magnification ×40; right-H&E: original magnification ×100.
Figure 3
Figure 3
CD4 and CD8 expression on the skin lesions. Upper left-CD4 immunohistochemistry (IHC) ×100; upper right-CD4 IHC ×200; lower left-CD8 IHC ×100: no staining; lower right-CD8 IHC ×200.
Figure 4
Figure 4
IL-17A expression was increased on the skin lesions. Expression of IL-17A on biopsy specimen from patient’s skin lesions was measured by IHC staining.
Figure 5
Figure 5
The timeline of diagnosis, interventions and outcomes of the present case.
See this image and copyright information in PMC

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