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Laryngeal Mucous Membrane Pemphigoid as an Immune-related Adverse Effect of Pembrolizumab Treatment

  • Antonia Lagos-Villaseca
    Affiliations
    UCSF Voice & Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, California

    Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • Vadim S. Koshkin
    Affiliations
    Division of Hematology/Oncology, Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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  • Maxime J. Kinet
    Affiliations
    Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California
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  • Clark A. Rosen
    Correspondence
    Address correspondence and reprint requests to Clark A. Rosen, UCSF Voice and Swallowing Center, 2330 Post Street, 5th Floor, San Francisco, CA 94115.
    Affiliations
    UCSF Voice & Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco, San Francisco, California
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Published:January 18, 2023DOI:https://doi.org/10.1016/j.jvoice.2022.12.028

      Summary

      Pembrolizumab is an immune checkpoint inhibitor (ICI) approved for multiple indications in a variety of malignancies. Although generally well tolerated, the potential for significant adverse effects, specifically immune related adverse effects (irAEs) needs to be taken into consideration. Several cases of bullous pemphigoid have been reported as a cutaneous adverse effect of ICIs since 2015, and there are recent reports of mucous membrane pemphigoid (MMP). We present the case of an 84-year-old male with metastatic urothelial carcinoma on treatment with pembrolizumab, who developed laryngeal mucous membrane pemphigoid as an irAE. The diagnosis was based on patient's clinical history and serologic testing, and supported by symptomatic improvement after ICI discontinuation and immunosuppression. Pembrolizumab-induced MMP is a newly described and infrequent irAE, requiring early suspicion and close monitoring for its diagnosis and management.

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