Nivolumab-associated DRESS syndrome: A case report

The recent development of immune checkpoint inhibitors such as PD-1/PD-L1 inhibitors and CTLA-4 inhibitors has revolutionized the approach to cancer therapy. However, with these advances comes a distinctive set of toxic effects, collectively named immune-related adverse events (IRAEs). The most common cutaneous manifestations of IRAEs include morbilliform eruptions, lichenoid reactions, pruritus, eczema, and vitiligo.1 Nevertheless, these manifestations can affect any tissue in various combinations. Drug reaction with eosinophilia and systemic symptoms (DRESS) is one example of such presentation. Although initially reported with anticonvulsants, the list of potential causative agents for DRESS has considerably lengthened over the years. We present a patient with a novel case of nivolumab-associated DRESS, with a discussion on the current challenges in diagnosis, especially in the context of immune checkpoint inhibitors.