Antineoplastics

S Antineoplastics Various toxicitiesA 46-year-old woman developed angioedema, hives and lichen planus pemphigoides during treatment with pembrolizumab and developed neuropathy during treatment with cisplatin, etoposide, doxorubicin and mitotane for metastatic adrenocortical carcinoma.Additionally, she exhibited a lack of efficacy during treatment with pembrolizumab, cisplatin, etoposide, doxorubicin and mitotane for metastatic adrenocortical carcinoma [not all routes, duration of treatments to reactions onsets and outcomes stated; dosages not stated].The woman had metastatic adrenocortical carcinoma for which she was initially started receiving treatment with cisplatin, etoposide, doxorubicin and oral mitotane.After six cycles of therapy, she developed neuropathy secondary to cisplatin, etoposide, doxorubicin and mitotane.Subsequently, she started treatment with pembrolizumab infusion.However, after 11 days of pembrolizumab initiation, she developed angioedema and hives secondary to pembrolizumab.Then, the woman was treated with unspecified antihistamines.After treatment, angioedema and hives resolved.Later, the woman received an additional three cycles of pembrolizumab infusion.Despite treatment with pembrolizumab, cisplatin, etoposide, doxorubicin and mitotane, progressive metastatic disease was noted indicating a lack of efficacy.Thereafter, her therapy with pembrolizumab was discontinued after fourth cycle.After one week of pembrolizumab cessation, she developed pruritic plaques and tense bulla on her trunk and extremities.The physical exam showed tense bullae and diffuse lichenoid plaques on her chest, abdomen, and extremities.A biopsy showed basilar dyskeratosis, subepidermal separation with a patchy dermal lymphocytic infiltrate, rare eosinophils and necrosis.Direct immunofluorescence revealed linear deposition of C3 and IgG along the basement-membrane zone.Thereafter, she was diagnosed with lichen planus pemphigoides secondary to pembrolizumab.Then, she was treated with prednisone, tetracaine, epinephrine and cocaine.After treatment, her lichen planus pemphigoides improved.