内容紹介
Summary
The patient was a 66-year-old male. Following surgery for pulmonary adenocarcinoma in the upper right lobe and adjuvant chemotherapy, the patient relapsed. We carried out treatment using the immune checkpoint inhibitor pembrolizumab(KEYTRUDAⓇ)for high expression of PD-L1. Following the first administration, severe drug eruption occurred and despite temporary improvement seen by intravenous infusion of steroids in combination with oral administration and external use thereof, it relapsed in the early stages and toxic epidermal necrosis developed. Skin problems were improved by multidisciplinary treatments such as gammaglobulin therapy, systemic steroid administration, and broad-spectrum antibiotics. There were no reports of toxic epidermal necrosis occurring during pembrolizumab administration for lung cancer. This case went through a unique course in which the disease relapsed into a more severe condition at an early stage following temporary remission.
要旨
症例は66歳,男性。右上葉肺腺癌術後,術後補助化学療法後に再発した。PD-L1高発現であり免疫チェックポイント阻害薬pembrolizumab(キイトルーダⓇ)での治療を行った。初回投与後に重症薬疹を発症し,ステロイド点滴静注および内服に外用を併用しいったんは改善したが,早期に再燃し中毒性表皮壊死症を発症した。ガンマグロブリン療法,全身ステロイド投与,広域抗生剤など集学的治療により皮膚障害は改善した。肺癌に対するpembrolizumab投与中の中毒性表皮壊死症の報告はなく,本症例はいったん軽快後により重篤な病態として早期に再燃するという特異な経過をたどった。
目次
The patient was a 66-year-old male. Following surgery for pulmonary adenocarcinoma in the upper right lobe and adjuvant chemotherapy, the patient relapsed. We carried out treatment using the immune checkpoint inhibitor pembrolizumab(KEYTRUDAⓇ)for high expression of PD-L1. Following the first administration, severe drug eruption occurred and despite temporary improvement seen by intravenous infusion of steroids in combination with oral administration and external use thereof, it relapsed in the early stages and toxic epidermal necrosis developed. Skin problems were improved by multidisciplinary treatments such as gammaglobulin therapy, systemic steroid administration, and broad-spectrum antibiotics. There were no reports of toxic epidermal necrosis occurring during pembrolizumab administration for lung cancer. This case went through a unique course in which the disease relapsed into a more severe condition at an early stage following temporary remission.
要旨
症例は66歳,男性。右上葉肺腺癌術後,術後補助化学療法後に再発した。PD-L1高発現であり免疫チェックポイント阻害薬pembrolizumab(キイトルーダⓇ)での治療を行った。初回投与後に重症薬疹を発症し,ステロイド点滴静注および内服に外用を併用しいったんは改善したが,早期に再燃し中毒性表皮壊死症を発症した。ガンマグロブリン療法,全身ステロイド投与,広域抗生剤など集学的治療により皮膚障害は改善した。肺癌に対するpembrolizumab投与中の中毒性表皮壊死症の報告はなく,本症例はいったん軽快後により重篤な病態として早期に再燃するという特異な経過をたどった。