Atezolizumab-induced scleroderma: a rare complication

BMJ Case Rep. 2021 Nov 11;14(11):e244968. doi: 10.1136/bcr-2021-244968.

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cases of programmed death-ligand 1 inhibitor-induced scleroderma have been reported and their clinical features remain unpublished.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.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / adverse effects
  • Carcinoma, Non-Small-Cell Lung* / drug therapy
  • Female
  • Humans
  • Lung Neoplasms* / chemically induced
  • Lung Neoplasms* / drug therapy
  • Scleroderma, Localized* / chemically induced

Substances

  • Antibodies, Monoclonal, Humanized
  • atezolizumab