SHM Converge Scientific Abstract ePoster Gallery-A "Rash" Decision: Diagnosing Acral Erythema Caused by Pembrolizumab

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This case report describes a 67-year-old woman with metastatic squamous cell lung cancer and a history of plaque psoriasis who developed 2 weeks of severe, painful, pruritic, desquamating erythematous skin lesions on the extremities, trunk, and abdomen while receiving pembrolizumab maintenance therapy. She had no new medications, exposures, or other clear triggers, and she felt the eruption was different from prior psoriasis flares.<br /><br />On admission, she was distressed by pain and itching. Labs showed leukocytosis and chronic anemia; blood cultures were negative. Lower-extremity Doppler ultrasound ruled out DVT. Skin biopsy from the left upper extremity was consistent with psoriasis, and fungal staining was negative. Because she was immunocompromised, empiric antibiotics were started initially. Oncology and dermatology were consulted, and both suspected acral erythema related to pembrolizumab.<br /><br />Pembrolizumab was held, and she was started on an oral prednisone taper along with supportive care, including topical steroids and emollients. Her skin gradually healed, and her hand and foot function improved. She was discharged with steroid-based therapy and continued supportive treatment.<br /><br />The report reviews pembrolizumab, a PD-1 inhibitor used in advanced melanoma and non-small cell lung cancer, and highlights immune-related dermatologic toxicities. Acral erythema, also called palmoplantar erythrodysesthesia, typically causes painful red lesions that can progress to desquamation, erosion, and ulceration. The authors note that pre-existing psoriasis may increase susceptibility to cutaneous immune-related adverse events.<br /><br />Overall, the case emphasizes the importance of early recognition of immunotherapy toxicity, prompt discontinuation of the offending agent when appropriate, and close collaboration between oncology and dermatology to optimize patient outcomes.

Asset Subtitle

Shamis Khan

Meta Tag

Author List Adrian Gonzalez Gil, Amer Alsoudi, Lubna Khawaja, Shamis Khan

Category Clinical Vignettes

Concept Pembrolizumab

Concept Acral Erythema

Concept Immune Checkpoint Inhibitor Toxicity

Concept Severe Cutaneous Adverse Reaction

Concept Immune Checkpoint Inhibitor

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Shamis Khan

Track Adult

Keywords

pembrolizumab

psoriasis

metastatic squamous cell lung cancer

acral erythema

palmoplantar erythrodysesthesia

immune-related adverse events

dermatologic toxicity

prednisone taper

skin biopsy

oncology dermatology collaboration

Pembrolizumab

Acral Erythema

Immune Checkpoint Inhibitor Toxicity

Severe Cutaneous Adverse Reaction

Immune Checkpoint Inhibitor