Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Farees Saqlain; Sophia Z Shalhout; Kevin S Emerick; Tomas G Neilan; Tatyana Sharova; David Michael Miller

doi:10.1155/2020/8890845

Metastatic Merkel Cell Carcinoma Masquerading as Multiple Immune-Related Adverse Events

Case Rep Dermatol Med. 2020 Sep 30:2020:8890845. doi: 10.1155/2020/8890845. eCollection 2020.

Authors

Farees Saqlain¹, Sophia Z Shalhout^{1

2}, Kevin S Emerick^{1

3

4}, Tomas G Neilan^{1

5}, Tatyana Sharova², David Michael Miller^{1

2

6}

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
³ Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
⁴ Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
⁵ Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.

Abstract

Merkel cell carcinoma is a rare cutaneous neuroendocrine carcinoma with a high rate of regional and distant metastasis and mortality. Here, we report a novel case of Merkel cell carcinoma which presented as a primary lesion to the left cheek with regional lymph node involvement and was treated with pembrolizumab and radiation. Widely metastatic disease eventually revealed on autopsy clinically mimicked immune-related organ insult leading to management with immunosuppressants. The patient also had a biopsy-confirmed immune-related cutaneous adverse event during admission. The case highlights a rare circumstance in which disease progression masqueraded as multiple immune-related end-organ adverse events. Contribution of on-target anti-PD-1 toxicity remains a possibility.

Publication types

Case Reports