PMC5836162_01
Clinical course of our case.
cde-0010-0001-g01.jpg
PMC5836162_01_cde-0010-0001-g01.jpg
F1
One week after the first administration of ipilimumab, she became ill and had a high-grade fever with pancytopenia (white blood cells: 1,400/microL [lymphocytes: 37%], red blood cells: 3.52 x 106/microL, platelets: 1.51 x 105/microL) (Fig. 1). Laboratory tests showed abnormal findings, including: white blood cells of 33,000/microL (lymphocytes: 0.1%), red blood cells of 5.29 x 106/microL, platelets of 1.15 x 105/microL, sIL2R of 6,580 U/ml (normal: 122-496 U/mL), and liver dysfunction, such as alanine transaminase level of 209 IU/L, aspartate transaminase level of 215 IU/L, and lactate dehydrogenase level of 686 IU/L (Fig. 1).
Multiple erythematous papules and nodules on our patient's trunk that spread to the extremities and face (a), accompanying mucosal involvement such as conjunctival injection (b). Soreness of the oral mucosa and dyspnea were noted.
cde-0010-0001-g02.jpg
PMC5836162_01_cde-0010-0001-g02.jpg
F2
Two days after tapering off her oral PSL to 35 mg/day, however, multiple erythematous papules and nodules developed on her trunk and spread to almost her entire body, with conjunctiva injection (Fig. 2a, b).
Histology of the skin biopsy from her abdominal erythematous papules showing multifocal epidermal necrosis and dense perivascular infiltration of lymphocytes (HE staining; a x100; b x400).
cde-0010-0001-g03.jpg
PMC5836162_01_cde-0010-0001-g03.jpg
F3
The pathology of the lesioned skin demonstrated liquefaction degeneration and individual cell keratinization in the epidermis, with lymphocytic and eosinophilic infiltration into the superficial dermis (Fig. 3a, b).