Stevens-Johnson syndrome during nivolumab treatment of NSCLC.

Stevens-Johnson syndrome (SJS) is a type IV hypersensitivity reaction, mainly to drugs, that presents as mucocutaneous blistering and sloughing and which may follow a devastating clinical course. Although its incidence is roughly 1–2 cases per million/year, the mortality rate may be as high as 30% when the condition progresses to toxic epidermal necrolysis (TEN; also known as Lyell’s syndrome). Many different drug classes have been implicated as causes of SJS (e.g. antibiotics, NSAIDs, anticonvulsants) [1]. Among them, immune checkpoint inhibitors, such as the anti-PD1 agent nivolumab, are emerging culprits. This is especially relevant considering that the use of such drugs in oncology is becoming more widespread in an ever-increasing number of cancer types. It has recently been reported that up to 22% of patients receiving anti-PD1 therapy develop inflammatory skin lesions ranging from mild maculopapular to severe SJS-like rashes [2]. To date, only a few case reports on SJS and TEN during treatment with either anti-PD1 alone [3-6] or in combination with radiotherapy [7] have been described. In January 2017, an otherwise healthy 59-year old female was diagnosed with stage IV squamous non-small-cell lung cancer with a left adrenal lesion and a left temporal cortical-subcortical brain metastasis. Following a decompressive craniotomy with surgical removal of the brain lesion, the patient received a first-line chemotherapy treatment with cisplatin and gemcitabine for 4 cycles. The CT scan reassessment performed in May 2017 showed lung and adrenal disease progression,