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Wu et al. J Cancer Metastasis Treat 2020;6:40 Journal of Cancer
DOI: 10.20517/2394-4722.2020.77 Metastasis and Treatment

Case Report Open Access

Nivolumab-induced severe bullous pemphigoid
in a patient with renal cancer: a case report and

literature review

Xiaorong Wu, Sreekanth Palvai, Awais Jalil

Department of Medical Oncology, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea,
Essex SS0 0RY, United Kingdom.

Correspondence to: Dr. Xiaorong Wu, Department of Medical Oncology, Southend University Hospital NHS Foundation Trust,
Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, United Kingdom. E-mail: Xiaorong.wu@nhs.net

How to cite this article: Wu X, Palvai S, Jalil A. Nivolumab-induced severe bullous pemphigoid in a patient with renal cancer: a
case report and literature review. J Cancer Metastasis Treat 2020;6:40. http://dx.doi.org/10.20517/2394-4722.2020.77.

Received: 30 Jul 2020 Accepted: 23 Oct 2020 Published: 29 Oct 2020
Academic Editor: Godefridus J. Peters Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
With the widespread use of immunotherapy in numerous solid tumours, immunotherapy-related adverse events
(irAEs) have started to emerge and bring new challenges for clinicians to manage. Among established irAEs,
dermatologic toxicity is one of the most common toxicities; it is often mild but can be severe and potentially
life-threatening, such as bullous pemphigoid. Here, we report a case of nivolumab-mediated severe, extensive,
refractory bullous pemphigoid involving both skin and oral mucosa in a patient with metastatic renal cancer. We
also summarise a list of selected case reports of immunotherapy-induced bullous pemphigoid by literature review.
We highlight various presentations, investigations and managements of this type of skin irAEs. Meantime, we
would like to discuss the correlation of skin irAEs incidence rate with immunotherapy drug benefit and resistance.

Keywords: Bullous pemphigoid, mucous membrane pemphigoid, immunotherapy, dermatologic toxicity, nivolumab

INTRODUCTION
Immunotherapy, such as anti-programmeddeath-1 (PD-1)/programmed death ligand 1 (PD-L1) antibody
or anti-CTLA 4 antibody or combination, has significantly improved survival of patients with various
malignancies. However, immunotherapy-related adverse events (irAEs) have started to emerge and bring
new challenges for oncologists to manage. Among the known irAEs, dermatologic toxicity is one of the

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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