Cyclosporine but not acitretin for psoriasis exacerbation and general Myalgia induced by Pembrolizumab in a patient with advanced esophageal cancer

Abstract

Pembrolizumab is a checkpoint inhibitor to treat cancers by boosting overall immunity with T-cell disinhibition. However, this nonselectively enhanced immunity could trigger de novo or aggravate autoimmune diseases. Only a few reports showed exacerbation of psoriasis after pembrolizumab. We reported a psoriatic patient with esophageal cancer experiencing exacerbation of psoriasis and general myalgia soon after pembrolizumab induction. These adverse effects failed initially to acitretin but responded successfully and durably to cyclosporine subsequently, suggesting immune targeting regimen could be a treatment choice for pembrolizumab-induced psoriasis. We briefly reviewed and discussed the limited numbers of reports regarding this scenario.

Keywords

• Anti-programmed cell death protein-1
• cyclosporine
• pembrolizumab
• psoriasis exacerbation
• recurrent esophageal cancer