Bullous pemphigoid.

Abstract

Bullous pemphigoid: case report A 65-year-old man developed bullous pemphigoid during treatment with ipilimumab and nivolumab for metastatic melanoma. The man, who had a medical history of metastatic melanoma, presented with worsening of pruritic and erythematous rash for 3 months. He had previosuly completed treatment with ipilimumab and had been receiving nivolumab injection. The rash was exacerbated by successive monthly nivolumab injections with severe flare occurring after the most recent nivolumab injection. Physical examination showed scattered, erythematous, maculopapular lesions in various stages of healing with secondary crusting and excoriation. Histopathological investigation of a skin punch biopsy including direct immunofluorescence showed linear deposition of C3 and IgG on the basement membrane. All these were consistent with bullous pemphigoid. His anti-BP-180 autoantibodies were found to be increased. Subsequently, nivolumab was stopped, and the man was treated with dapsone, unspecified antihistamines and unspecified steroids. Eventually, the rash improved. Later, it was confirmed that his bullous pemphigoid was associated with ipilimumab and nivolumab.