medwireNews: Two case studies reported in the Journal of Thoracic Oncology show that lung cancer patients receiving treatment with PD-1 inhibitors can present with atypical and severe skin manifestations when infected with SARS-CoV-2.
According to Andrés Cardona (Foundation for Clinical and Applied Cancer Research – FICMAC, Bogotá, Colombia) and co-authors, both patients achieved a major response to at least 1 year of treatment with an anti-PD1 antibody and had no history of prior skin manifestations until the onset of COVID19.
Neither patient had major respiratory symptoms at COVID-19 diagnosis, nor did they have elevated interleukin-6 levels, an important predictor of COVID19-associated fatality.
The first case involved a male smoker diagnosed with stage IV squamous cell lung carcinoma in 2017 at 62 years of age.
He was treated with ipilimumab plus nivolumab until March 2020, with the exception of a break to undergo neurosurgical resection followed by stereotactic radiosurgery (SRS) for brain metastases.
Cardona et al explain that the patient developed fever, fatigue, myalgia, and chills 2 days after being in contact with a patient showing signs of flu.
The patient then developed “persistent” urticaria with minimal erythema and a burning sensation on the lower back. These lesions were accompanied by severe joint pain and reactive polyarthritis.
Laboratory analyses confirmed SARS-CoV-2 infection, as well as elevated ferritin and D-dimer levels that continued to increase following the initiation of hydroxychloroquine. Skin pathology results showed urticarial vasculitis with signs of microangiothrombosis.
After 6 days, the patient was additionally treated with azithromycin, methylprednisolone, and enoxaparin, and 4 days later most skin lesions had resolved, and the patient’s chest computed tomography results were normal.
Cardona and team also note that antinuclear antibody, complement C4, and fibrinogen levels, as well as clotting times were normal throughout the infection.
The second patient was a 58-year old female former smoker who was diagnosed with metastatic lung adenocarcinoma in 2019 and treated with carboplatin plus pemetrexed and pembrolizumab. She also received SRS, which was followed by pemetrexed plus pembrolizumab maintenance therapy.
Three days after contact with a confirmed SARS-CoV-2-positive individual, she developed diarrhea, fever, and a dry cough without dyspnea, followed 2 days later by the “progressive appearance of several lesions with targetoid morphology, a peripheral rim of erythema, and a central zone of pallor,” as well as painful oral ulcers, the researchers say.
The patient’s diagnosis of SARS-CoV-2 infection was confirmed and skin biopsy showed “necrotic keratinocytes within the epidermis” and “an interface dermatitis consistent with an erythema multiforme,” the team continues.
Cardona et al write that the patient was treated with hydroxychloroquine, hydroxyzine, desloratadine, and methylprednisolone that together rapidly controlled the symptoms and reduced levels of ferritin and C-reactive protein.
And the team concludes: “At this moment, the possibility to modulate diverse inflammatory manifestations derived from COVID19 in cancer patients, many of them exposed to immunotherapy, remains open.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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