Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Nov 11;14(11):e244968.
doi: 10.1136/bcr-2021-244968.

Atezolizumab-induced scleroderma: a rare complication

Christon Grant  1 , Varun Chalasani  2 , Jeffrey M Uchin  3 , Adam Dore  1
Affiliations
Case Reports

Atezolizumab-induced scleroderma: a rare complication

Christon Grant et al. BMJ Case Rep. .

Abstract

Few cases of programmed death-ligand 1 inhibitor-induced scleroderma have been reported and their clinical features remain unpublished. Optimal management is, therefore, unknown and an autoantibody association has yet to be identified. We present the case of a female in her 60s who developed skin thickening after starting atezolizumab for metastatic non-small cell lung cancer. Skin biopsy 7 months after symptom onset showed histological changes consistent with scleroderma. Anti-PM/SCL-75 antibody was positive. Atezolizumab was discontinued and treatment was started with mycophenolate mofetil. After 5 months, she experienced mild improvement in skin thickening. Earlier identification of this complication may limit morbidity in this disease process, which otherwise has limited treatment options. In suspected cases, obtaining scleroderma-associated autoantibodies may help with earlier diagnosis.

Keywords: chemotherapy; connective tissue disease; lung cancer (oncology); oncology; rheumatology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Indurated skin of bilateral feet.
Figure 2
Figure 2
Indurated skin of the lower extremity.
Figure 3
Figure 3
Pathology slide showing the loss of normal epidermal rete architecture and dermal thickening accompanied by enlarged/swollen collagen bundles.
See this image and copyright information in PMC

References

    1. Tjarks BJ, Kerkvliet AM, Jassim AD, et al. . Scleroderma-like skin changes induced by checkpoint inhibitor therapy. J Cutan Pathol 2018;45:615–8. 10.1111/cup.13273 - DOI - PubMed
    1. Terrier B, Humbert S, Preta L-H, et al. . Risk of scleroderma according to the type of immune checkpoint inhibitors. Autoimmun Rev 2020;19:102596. 10.1016/j.autrev.2020.102596 - DOI - PubMed
    1. Wei SC, Duffy CR, Allison JP. Fundamental mechanisms of immune checkpoint blockade therapy. Cancer Discov 2018;8:1069–86. 10.1158/2159-8290.CD-18-0367 - DOI - PubMed
    1. Buchbinder EI, Desai A. Ctla-4 and PD-1 pathways: similarities, differences, and implications of their inhibition. Am J Clin Oncol 2016;39:98–106. 10.1097/COC.0000000000000239 - DOI - PMC - PubMed
    1. Das S, Johnson DB. Immune-Related adverse events and anti-tumor efficacy of immune checkpoint inhibitors. J Immunother Cancer 2019;7:306. 10.1186/s40425-019-0805-8 - DOI - PMC - PubMed

Publication types

MeSH terms

Substances