Remote presentation of nivolumab-induced bullous pemphigoid in hepatocellular carcinoma

Document Type

Journal Article

Publication Date

4-8-2025

Journal

BMJ case reports

Volume

18

Issue

4

DOI

10.1136/bcr-2024-263285

Keywords

Contraindications and precautions; Hepatic cancer; Immune Checkpoint Inhibitors; Immunological products and vaccines; Skin

Abstract

A man in his 70s with a history of unresectable hepatocellular carcinoma (HCC) treated with nivolumab presented with a blistering rash 14 months after nivolumab initiation. Biopsies and direct immunofluorescence confirmed the diagnosis of bullous pemphigoid (BP). BP is an autoimmune skin disorder in which autoantibodies bind to the dermal-epidermal junction. It is a rare sequela of programmed cell death protein-1 (PD-1) inhibitors that can develop after treatment initiation and typically resolve soon after discontinuation. Most cases are reported in melanoma and non-small cell lung cancers, and rarely in HCC irrespective of the timing of onset. We describe a rare presentation of remote BP with PD-1 inhibitor use in HCC. PD-1 inhibitor-induced BP is a rare cutaneous immune-related adverse event, and this case highlights the variability in onset and chronicity.

Department

School of Medicine and Health Sciences Resident Works

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