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1</a>D&#44;E&#41;&#46; La inmunofluorescencia directa fue negativa para inmunoglobulinas o dep&#243;sitos de C3 en la membrana basal epid&#233;rmica&#46; Por tanto&#44; fue tratada con corticosteroides t&#243;picos&#44; sin discontinuaci&#243;n de nivolumab&#44; aunque con efectos insuficientes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Caso 2&#46; Un var&#243;n de 81 a&#241;os fue tratado con administraci&#243;n de pembrolizumab &#40;3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41; cada tres semanas&#44; debido a CPCNP&#46; Tras la novena infusi&#243;n&#44; fue derivado al Departamento de Dermatolog&#237;a del Hospital Universitario M&#233;dico de Fukushima&#44; reportando erupci&#243;n cut&#225;nea pruriginosa en la parte inferior de los muslos&#46; Tras la duod&#233;cima infusi&#243;n comenzaron a aparecer eritema y m&#250;ltiples placas de color rojo oscuro&#44; bien definidas&#44; cubiertas de escamas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A&#41;&#46; El examen histol&#243;gico revel&#243; hiperqueratosis focal con ortoqueratosis&#44; hiperplasia de la capa granular&#44; hiperproliferaci&#243;n epid&#233;rmica irregular y leve degeneraci&#243;n de la licuefacci&#243;n de las capas basales&#44; y edema de la dermis papilar &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#44;C&#41;&#46; Se observ&#243; un infiltrado de tipo banda de c&#233;lulas inflamatorias&#44; principalmente compuesto de c&#233;lulas<span class="elsevierStyleHsp" style=""></span>T CD4&#8722; y CD8&#43;&#44; en la dermis superior &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>D&#44;E&#41;&#46; Fue tratado con corticosteroides t&#243;picos y antihistam&#237;nicos orales&#44; sin discontinuaci&#243;n de pembrolizumab&#44; con efectos satisfactorios&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Hasta la fecha se han reportado casos de exacerbaci&#243;n de psoriasis preexistente o inducci&#243;n <span class="elsevierStyleItalic">de novo</span> de psoriasis&#47;erupciones psoriasiformes durante la terapia de nivolumab&#46; Sin embargo&#44; la inducci&#243;n de LP es rara&#46; Existen diversos informes sobre LP o dermatitis liquenoide<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1-6</span></a>&#46; En un estudio unic&#233;ntrico de cohorte se observaron reacciones liquenoides en el 17 al 82&#37; de los pacientes con melanoma metast&#225;sico que recibieron terapia anti-PD-1<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Histopatol&#243;gicamente&#44; el grado de dermatitis de interfase y cambios epid&#233;rmicos son variables&#46; El LP ampollar se observa a menudo en los miembros inferiores&#46; Histopatol&#243;gicamente&#44; la biopsia de la lesi&#243;n ampollosa se caracteriza por una ampolla subepid&#233;rmica acompa&#241;ada de cambios cl&#225;sicos del LP&#46; La formaci&#243;n de ampollas puede deberse a la amplia licuefacci&#243;n y vacuolizaci&#243;n de la capa basal&#46; En el caso<span class="elsevierStyleHsp" style=""></span>1&#44; 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Carta científico-clínica
Liquen plano bulloso y no-ampolloso durante la terapia anti PD-1 para el cáncer de pulmón
Bullous and Non-Bullous Lichen Planus During Anti PD-1 Therapy for Lung Cancer
Y. Hanami
Corresponding author
yuka-66@fmu.ac.jp

Autor para correspondencia.
, T. Yamamoto
Department of Dermatology, Fukushima Medical University, Fukushima, Japón
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cada dos semanas&#44; debido a CPCNP&#46; Tras la tercera infusi&#243;n&#44; comenzaron a aparecer erupciones pruriginosas en las piernas&#46; La exploraci&#243;n f&#237;sica revel&#243; m&#250;ltiples placas querat&#243;sicas viol&#225;ceas&#44; bien definidas&#44; ligeramente cubiertas de escamas en la parte inferior de ambas piernas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; El examen histol&#243;gico revel&#243; hiperqueratosis focal con paraqueratosis&#44; p&#233;rdida focal de la capa granular&#44; hiperproliferaci&#243;n epid&#233;rmica irregular y leve degeneraci&#243;n de la licuefacci&#243;n de las capas epid&#233;rmicas basales&#44; con edema subepid&#233;rmico prominente &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#44;C&#41;&#46; Se observ&#243; infiltrado de c&#233;lulas mononucleares&#44; principalmente compuesto de c&#233;lulas T CD4&#8722; y CD8&#43; en la dermis superior &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#44;E&#41;&#46; La inmunofluorescencia directa fue negativa para inmunoglobulinas o dep&#243;sitos de C3 en la membrana basal epid&#233;rmica&#46; Por tanto&#44; fue tratada con corticosteroides t&#243;picos&#44; sin discontinuaci&#243;n de nivolumab&#44; aunque con efectos insuficientes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Caso 2&#46; Un var&#243;n de 81 a&#241;os fue tratado con administraci&#243;n de pembrolizumab &#40;3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#41; cada tres semanas&#44; debido a CPCNP&#46; Tras la novena infusi&#243;n&#44; fue derivado al Departamento de Dermatolog&#237;a del Hospital Universitario M&#233;dico de Fukushima&#44; reportando erupci&#243;n cut&#225;nea pruriginosa en la parte inferior de los muslos&#46; Tras la duod&#233;cima infusi&#243;n comenzaron a aparecer eritema y m&#250;ltiples placas de color rojo oscuro&#44; bien definidas&#44; cubiertas de escamas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A&#41;&#46; El examen histol&#243;gico revel&#243; hiperqueratosis focal con ortoqueratosis&#44; hiperplasia de la capa granular&#44; hiperproliferaci&#243;n epid&#233;rmica irregular y leve degeneraci&#243;n de la licuefacci&#243;n de las capas basales&#44; y edema de la dermis papilar &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#44;C&#41;&#46; Se observ&#243; un infiltrado de tipo banda de c&#233;lulas inflamatorias&#44; principalmente compuesto de c&#233;lulas<span class="elsevierStyleHsp" style=""></span>T CD4&#8722; y CD8&#43;&#44; en la dermis superior &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>D&#44;E&#41;&#46; Fue tratado con corticosteroides t&#243;picos y antihistam&#237;nicos orales&#44; sin discontinuaci&#243;n de pembrolizumab&#44; con efectos satisfactorios&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Hasta la fecha se han reportado casos de exacerbaci&#243;n de psoriasis preexistente o inducci&#243;n <span class="elsevierStyleItalic">de novo</span> de psoriasis&#47;erupciones psoriasiformes durante la terapia de nivolumab&#46; Sin embargo&#44; la inducci&#243;n de LP es rara&#46; Existen diversos informes sobre LP o dermatitis liquenoide<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1-6</span></a>&#46; En un estudio unic&#233;ntrico de cohorte se observaron reacciones liquenoides en el 17 al 82&#37; de los pacientes con melanoma metast&#225;sico que recibieron terapia anti-PD-1<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Histopatol&#243;gicamente&#44; el grado de dermatitis de interfase y cambios epid&#233;rmicos son variables&#46; El LP ampollar se observa a menudo en los miembros inferiores&#46; Histopatol&#243;gicamente&#44; la biopsia de la lesi&#243;n ampollosa se caracteriza por una ampolla subepid&#233;rmica acompa&#241;ada de cambios cl&#225;sicos del LP&#46; La formaci&#243;n de ampollas puede deberse a la amplia licuefacci&#243;n y vacuolizaci&#243;n de la capa basal&#46; En el caso<span class="elsevierStyleHsp" style=""></span>1&#44; las placas querat&#243;sicas viol&#225;ceas aparecieron en las piernas tras el inicio de la administraci&#243;n de nivolumab&#46; El examen histopatol&#243;gico revel&#243; hiperproliferaci&#243;n epid&#233;rmica irregular&#44; con edema subepid&#233;rmico marcado&#46; Wakade et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> reportaron tres casos de reacciones de tipo LP ampollar inducidas por el inhibidor de PD-1 tras 2-22 ciclos de administraci&#243;n&#46; Dos de los pacientes ten&#237;an CPCNP&#44; y el tercero de ellos ten&#237;a melanoma&#46; Biolo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> reportaron recientemente un caso inusual de LP ampollar lineal que comprometi&#243; unilateralmente el miembro inferior&#44; con tratamiento de nivolumab&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se ha sugerido que la patogenia de LP es debida al da&#241;o epid&#233;rmico causado por las c&#233;lulas<span class="elsevierStyleHsp" style=""></span>T CD8&#43; citot&#243;xicas autorreactivas&#44; mediado por interfer&#243;n-&#947; &#40;IFN-&#947;&#41;&#46; En los modelos murinos de LP&#44; la expresi&#243;n prominente de PD-L1 en los queratinocitos es sugestiva de jugar un papel protector frente a las c&#233;lulas<span class="elsevierStyleHsp" style=""></span>T CD8&#43; citot&#243;xicas<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; Adem&#225;s&#44; los estudios <span class="elsevierStyleItalic">in vitro</span> reflejaron que la administraci&#243;n de anticuerpos anti-PD-1 indujo un incremento de la producci&#243;n de IFN-&#947; de las c&#233;lulas mononucleares de sangre perif&#233;rica de los pacientes con LP oral<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Komori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> reportaron recientemente un caso que desarroll&#243; LP focalmente en una zona irradiada&#44; 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Article information
ISSN: 00017310
Original language: Spanish
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