Case Report: Immune-related eruptive keratoacanthoma with fungal coinfection under PD-1 inhibitor therapy: a diagnostic and therapeutic challenge

Case Report: Immune-related eruptive keratoacanthoma with fungal coinfection under PD-1 inhibitor therapy: a diagnostic and therapeutic challenge

BackgroundIt has been reported that immunotherapy with programmed cell death protein 1 (PD-1) inhibitors (pembrolizumab or nivolumab) can induce multiple eruptive keratoacanthomas (KAs), representing an immune-related cutaneous adverse event (ircAE).MethodsThis case report describes a 63-year-old fe...

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Main Authors: Ying-Jie Su, Zheng Wu, Yan-Li Hou, Meng-Xia Yan, Xiu-Mei Ma, Hou-Wen Lin
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-08-01
Series:Frontiers in Pharmacology
Subjects:
immune checkpoint inhibitors
programmed cell death protein 1
immune-related adverse event
immune-related cutaneous adverse event
eruptive keratoacanthomas
Online Access:https://www.frontiersin.org/articles/10.3389/fphar.2025.1619450/full
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Summary:BackgroundIt has been reported that immunotherapy with programmed cell death protein 1 (PD-1) inhibitors (pembrolizumab or nivolumab) can induce multiple eruptive keratoacanthomas (KAs), representing an immune-related cutaneous adverse event (ircAE).MethodsThis case report describes a 63-year-old female with recurrent cervical adenocarcinoma who developed multiple eruptive KAs and a concurrent fungal infection following treatment with the PD-1 inhibitor zimberelimab. We analyzed the etiology, diagnosis, and treatment by integrating clinical manifestations, pathological examinations, previous treatment history, and a review of the literature.ResultsDespite an initial misdiagnosis as a fungal infection, multidisciplinary review identified KA as an ircAE. Topical corticosteroids led to resolution, and another PD-1 inhibitor was reintroduced without recurrence of cutaneous toxicity.ConclusionThis is the first documented case of eruptive KA linked to zimberelimab, expanding the spectrum of PD-1 inhibitor-associated ircAEs. A concurrent fungal infection obscured the diagnosis, delaying appropriate treatment and highlighting the importance of recognizing rare ircAEs and multidisciplinary collaboration.
ISSN:1663-9812

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