ArticleFrontiers in medicine2026
Rapid progression to toxic epidermal necrolysis following switch of PD-1 inhibitors: a case report.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Immune checkpoint inhibitors (ICIs) have been widely used in clinical practice in recent years. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially life-threatening cutaneous adverse reactions associated with ICIs. This report describes a 69-years-old male with recurrent hypopharyngeal cancer who experienced only recurrent Grade 1 maculopapular rash during treatment with tislelizumab combined with chemotherapy and subsequent maintenance therapy. However, within 2 days after switching to pembrolizumab, his condition deteriorated rapidly into TEN, involving over 95% of the body surface area and multiple mucosal sites including the oral cavity and conjunctivae. Skin biopsy revealed epidermal necrosis, subepidermal clefts, and infiltration of CD4 and CD8 positive T lymphocytes. Immunohistochemistry demonstrated positive PD-L1 expression but negative PD-1 expression. These pathological findings suggested that alterations in the local cutaneous immune microenvironment following sequential administration of different PD-1 inhibitors might play a critical role in the fulminant progression of TEN.
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