Annals of dermatology最新文献

Sintilimab is an anti-programmed cell death receptor-1 antibody. The phase III clinical trial ORIENT-12 confirmed the safety of sintilimab combined with pemetrexed/platinum in the treatment of advanced squamous non-small cell lung cancer. Skin reactions are the most commonly reported adverse events of immune checkpoint inhibitors and are rarely severe. We describe a case of toxic epidermal necrolysis related to sintilimab in an elderly oncologic patient. 3 weeks after immunotherapy, the patient developed an extensive rash and diffuse itching, rapidly evolving into macules, blisters, bullae and erosions. Causal evaluation was performed based on the algorithm of drug causality for epidermal necrolysis and national Food and Drug Administration qualitative analysis. The patient responded to high-dose glucocorticosteroid and supportive therapy, alongside with local wound care. If immune checkpoint inhibitors need to be extrapolated clinically, strictly following evidence-based research, promptly detecting and treating adverse reactions is crucial.

Juvenile gangrenous vasculitis is characterized by the abrupt onset of scrotal ulcerations in young males, preceded by fever and pharyngeal symptoms. The etiology of this disease is poorly understood. The course is benign and self-limiting within a few weeks with no relapse. Because of its rare incidence, physicians often confuse it with Fournier's gangrene, which progresses rapidly to severe systemic symptoms requiring urgent surgical intervention. Herein, we report a rare case of juvenile gangrenous vasculitis of the scrotum and emphasize the importance of awareness of this diagnosis to avoid unnecessary invasive surgical intervention. A 17-year-old boy presented with painful and tender, diffuse erythema and swelling with a necrotic lesion on the scrotum for three days. Preceding the cutaneous manifestations, he had a fever and sore throat. Physical examination showed an about 2 cm-sized well-demarcated necrotic lesion on the anterior scrotum. Laboratory findings revealed neutrophilic leukocytosis with an elevated C-reactive protein and erythrocyte sedimentation rate. On scrotal ultrasonography, only edematous skin thickening and an increase in vascularity were observed. Histopathological examination showed epidermal necrosis and dermal neutrophilic infiltration. Empirical antibiotic treatment with ampicillin/sulbactam and clindamycin was administered and a prompt clinical resolution was observed.

A 38-year-old female with systemic lupus erythematosus (SLE) initiated belimumab treatment. One month later, she presented with a reddish painful swelling on her right lower leg. She was treated with ceftriaxone and vancomycin. However, novel erythematous papules and indurated nodules appeared on both her lower legs. Skin biopsy revealed microabscess formation with mixed cell granuloma surrounded by inflammatory cell infiltration within the dermis with subcutaneous fat tissue. A large number of acid-fast bacilli were observed with Ziehl-Neelsen staining. DNA sequencing of both the hsp65 and the 16S rRNA sequences showed a 100% match with the corresponding region of Mycobacterium haemophilum. Mycobacterial culture revealed satellite growth enhancement on Middlebrook 7H11 agar plates around a paper strip containing hemin. She was treated with levofloxacin, rifabutin, and ethambutol. Within 13 months, her cutaneous lesions improved markedly without any side effects. The B cell-targeted biologic belimumab, a fully humanized IgG1γ monoclonal antibody that inactivates B lymphocyte stimulator, has been considered to be beneficial for active SLE. However, this therapy could increase the risk for the development of biologic therapy-associated mycobacterial infections, both tuberculosis and nontuberculous mycobacteria infections.