SHM Converge Scientific Abstract ePoster Gallery-Spare the Steroids! Dupilumab for Steroid-Refractory Bullous Pemphigoid

Pdf Summary

This case report describes bullous pemphigoid, a rare but increasingly recognized immune-related adverse event from immune checkpoint inhibitors (ICIs), including PD-1 and PD-L1 therapies. The authors present a 66-year-old man with stage III squamous cell lung cancer who developed a vesicular, intensely pruritic rash about 8 months after starting durvalumab. Skin biopsy and direct immunofluorescence confirmed urticarial bullous pemphigoid, and labs showed marked eosinophilia.<br /><br />Current ASCO guidelines recommend dermatology referral and skin biopsy for workup. For management, they advise topical corticosteroids for mild disease and holding immunotherapy with systemic steroids for grade 3 toxicity or worse. However, these guidelines do not specifically address severe or steroid-refractory bullous pemphigoid.<br /><br />The patient was initially treated with high-dose prednisone, but the report highlights dupilumab as an effective adjunctive therapy when corticosteroids are insufficient or cause dependence. Adding dupilumab may lead to faster symptom resolution, reduce steroid exposure, and potentially allow continuation of immunotherapy in selected cases.<br /><br />The key teaching point is that clinicians should promptly recognize rare cutaneous toxicities during ICI treatment, because early diagnosis and multidisciplinary coordination between hospital medicine, dermatology, and oncology can improve outcomes and preserve cancer therapy when possible.

Asset Subtitle

Sundeep Kaur

Meta Tag

Author List Melissa Neumann, Nagrashree Seetharamu, Sheila Shaigany, Sundeep Kaur

Category Clinical Vignettes

Concept Bullous Pemphigoid

Concept Immune Checkpoint Inhibitor

Concept Cutaneous Adverse Effect

Concept Skin Toxicity

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset NY, USA

Presenting Author Sundeep Kaur

Track Adult

Keywords

bullous pemphigoid

immune checkpoint inhibitors

durvalumab

immune-related adverse event

cutaneous toxicity

dupilumab

prednisone

eosinophilia

skin biopsy

dermatology referral

Bullous Pemphigoid

Immune Checkpoint Inhibitor

Cutaneous Adverse Effect

Skin Toxicity

Corticosteroid