Delayed Immune-Related Erythrodermia in a Squamous NSCLC Patient Treated with Nivolumab: A Case Report

Immunotherapy has been changing the scenario of the treatment of non-small cell lung cancer (NSCLC) and is leading to a dramatic improvement in the clinical outcome of patients suffering from this disease. Immunotherapy has a specific toxicity profile and many oncologists are facing a new challenge in the form of clinical management of immune-related adverse events (irAEs). Even though most irAEs remain mild in intensity, around 10% of patients treated with anti-PD1/anti-PDL1 drugs will develop severe, sometimes life-threatening, dysimmune toxicities. Skin toxicity is one of the most common irAEs. The irAEs related to skin toxicity can have many different presentations, which includes maculopapular or papulopustular rash, Sweet’s syndrome, follicular or urticarial dermatitis. It typically occurs within 6 weeks from the beginning of the treatment but, due to the mechanism of action of immunotherapic drugs, delayed toxicities are reported. We present a case study of delayed grade 4 skin toxicity in a 75-year-old male patient with stage IV squamous NSCLC treated with Nivolumab.