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CASE REPORT
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 40-43

Lichen planus pemphigoides versus bullous pemphigoid: A diagnostic dilemma of cutaneous adverse event in a case of nonsmall cell lung cancer treated with durvalumab


Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India

Correspondence Address:
Sunanda Arun Mahajan
Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdd.ijdd_11_20

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Monoclonal antibodies targeting the immune checkpoint pathways including programmed cell death 1 and programmed cell death ligand-1 have been used in several malignancies. Dermatological toxicities ranging from more common pruritus to rare autoimmune bullous reactions and lichenoid eruptions are an emerging consequence. We report a case of a 74-year-old male diagnosed with nonsmall cell lung carcinoma. He was treated with injection durvalumab following which he developed an itchy, erythematous to hyperpigmented, papular eruption over body. It was diagnosed as a lichenoid drug eruption based on clinicohistopathological correlation and was treated with topical corticosteroids and emollients. Following this, he presented with tense bullae all over the body including the areas of previous lichenoid eruption, associated with pruritus. The histopathology, immunofluorescence, and serology were diagnostic of bullous pemphigoid. However, considering the history, lichen planus pemphigoides (LPP) was the closest differential diagnosis. We treated him with systemic corticosteroids and tetracycline with resolution of the lesions in few weeks and was advised against the continuation of durvalumab therapy. In this article, we have highlighted this adverse event as well as a way to differentiate between LPP and bullous pemphigoid.


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