Dermatitis bullosa caused by the immune checkpoint inhibitor camrelizumab: A case report.

backgroundSince the advent of the 20 CASE SUMMARY: Arimab (camrelizumab), a monoclonal antibody targeting programmed death protein 1 (PD-1), disrupts the PD-1/ programmed death ligand 1 (PD-L1) interaction, reactivating T cell function and triggering anti-tumor immunity. However, this disruption may trigger immune-mediated adverse events akin to autoimmune disorders. Approximately 2.8% of such events manifest as immune-related dermatologic reactions, with 0.7% classified as grade 3, which are infrequently documented. Here, this study describes a case of grade 3 bullous dermatitis occurring 15 days after initiating camrelizumab therapy. The patient, a 67-year-old male with oesophageal squamous cell carcinoma, received camrelizumab plus paclitaxel alongside chemotherapy and radiotherapy in early 2022. Due to disease progression, maintenance monotherapy with camrelizumab (200 mg) commenced in June 2022. On the fourth cycle, 15 days into treatment, the patient presented with an immune-checkpoint inhibitor-related rash, despite unremarkable test results. Dermatology and pharmacy consultations were conducted, leading to glucocorticoid therapy, topical interventions, and supportive care. Gastric mucosal protection, nutritional supplementation, and other adjunctive treatments were also provided. The patient's symptoms resolved within 15 days post-discharge, resulting in discontinuation of camrelizumab. Like other PD-1 inhibitors, camrelizumab is associated with immune-mediated dermatitis. Thus, optimal management of these events requires a multidisciplinary approach, vigilant monitoring, regular evaluations, prompt glucocorticoid administration, and specialized dermatologic care.

conclusionThe increasing adoption of immune checkpoint inhibitors in clinical practice has prompted substantial concerns about their safety profile. A wide range of immune-related adverse events and corresponding management strategies have been well-documented. Early recognition and accurate diagnosis, combined with interdisciplinary collaboration and swift initiation of immunosuppressive therapy, are essential in managing severe immune-related adverse reactions effectively. This report details the treatment trajectory and outcome of a case involving immune-related cutaneous adverse reactions, providing pertinent clinical insights for future cases.