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Year : 2020  |  Volume : 24  |  Issue : 2  |  Page : 137-139

Atypical Stevens–Johnson syndrome caused by pembrolizumab in the treatment of metastatic melanoma – Are corticosteroids a safe treatment option?

1 Department of Dermatology, University Hospital Waterford, Waterford, Ireland
2 Department of Oncology, University Hospital Waterford, Waterford, Ireland

Correspondence Address:
Dr. Cathal OConnor
Department of Dermatology, University Hospital Waterford, Waterford
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdds.jdds_73_20

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Pembrolizumab is a humanized monoclonal antibody that targets programmed cell death receptor-1. Stevens–Johnson syndrome (SJS) secondary to pembrolizumab has rarely been described in the treatment of malignant melanoma (MM). A 62-year-old woman developed a widespread bullous eruption following administration of her third dose of pembrolizumab for the treatment of MM. A skin biopsy showed sub-epidermal bulla formation with lymphocytic infiltrate and a necrotic roof, consistent with a SJS/toxic epidermal necrolysis (TEN) disorder. Intravenous methylprednisolone was administered. Upon cessation of oral prednisolone, there was a recrudescence of the eruption. A repeat skin biopsy confirmed recurrent SJS. Following a prolonged taper with oral prednisolone, there was no further relapse of SJS. Severe cutaneous adverse reactions such as SJS/TEN have been reported with pembrolizumab and can be associated with significant morbidity and even mortality. High-dose systemic corticosteroids are frequently used in its treatment. Concerns about the potential negative effect of high-dose steroids have re-surfaced, given the observed reduced overall survival in patients with MM. Due to difficulties in performing studies in this population, the benefits and risk of steroids should be considered on a case-by-case basis.

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