Herpes zoster granulomatous dermatitis in metastatic lung cancer treated with nivolumab: A case report.

Thoracic Cancer
Elisa GozziSilverio Tomao

Abstract

Granulomatous dermatitis (GD) is the most common among a variety of skin reactions that may occur in the varicella-zoster virus (VZV) reactivation area. It is thought that the formation of granulomas may be the result of a delayed hypersensitivity reaction to viral envelope glycoproteins. Immune checkpoint inhibitors (ICIs), such as nivolumab stimulate T cells and promote hypersensitivity reactions, leading to the formation of granulomas in VZV wrapping proteins, thus triggering VZV-GD. Few cases of the use of ICIs in patients diagnosed with VZV-GD have been reported in the literature. Here, we report the clinical case of a patient with metastatic lung cancer which was treated with nivolumab who subsequently developed VZV-GD. Accurate clinical diagnosis and prompt treatment with antiviral agents have resulted in a complete resolution of the clinical picture. KEY POINTS: Significant findings Treatment with ICIs may result in VZV reactivation. Accurate differential diagnosis and early treatment led to the resolution of VZV-GD. WHAT THIS STUDY ADDS: Few cases of ICI and VZV reactivation have been reported in the literature. Full and timely resolution of VZV-GD allowed the continuation of ICI treatment.

References

Jul 19, 2013·The New England Journal of Medicine·Jeffrey I Cohen
May 15, 2015·Journal of Cutaneous Pathology·Katalin FerencziStephen C Somach
Apr 5, 2016·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·V R BelumM E Lacouture
Sep 9, 2017·Annals of Oncology : Official Journal of the European Society for Medical Oncology·J B A G HaanenUNKNOWN ESMO Guidelines Committee
Apr 5, 2019·Immunotherapy·Tarek AssiVincent Ribrag
Jul 1, 2017·Annals of Oncology : Official Journal of the European Society for Medical Oncology·J B A G HaanenUNKNOWN ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org

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biopsy

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