CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicCommunity Series in Reducing Adverse Effects of Cancer Immunotherapy: Volume IIIView all 22 articles
Sintilimab-Induced Toxic Epidermal Necrolysis Complicated in Advanced Gastric Cancer: A Case Report and Literature Review
Provisionally accepted
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Immune checkpoint inhibitors (ICIs) can trigger immune-related adverse events (irAEs), among which Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is exceptionally rare but potentially fatal. Sintilimab, a PD-1 inhibitor increasingly used for advanced gastric cancer, has only sporadically been linked to SJS/TEN. Case presentation: We report a 60-year-old man with metastatic gastric adenocarcinoma who developed TEN 7 days after the first sintilimab infusion. He presented with rapidly progressive diffuse erythema, bullae, and epidermal detachment involving >90% of the body surface area, accompanied by fever and upper gastrointestinal bleeding leading to hemodynamic instability. Interventions: Sintilimab was permanently discontinued. Multidisciplinary management was initiated, including intensive fluid and electrolyte resuscitation, high-dose intravenous immunoglobulin, systemic corticosteroids with careful bleeding surveillance, specialized burn-type wound care, tailored anti-infective therapy based on susceptibility testingburn-oriented wound care, targeted anti-infective therapy, and aggressive nutritional support. This case report was prepared in accordance with the CARE (CAse REport) guidelines. The study followed STROCSS reporting guidance. Outcomes: Skin lesions gradually re-epithelialized, infection was controlled, and gastrointestinal bleeding stabilized. The patient fully recovered from TEN and was discharged on hospital day 32. No recurrence or secondary infection was observed on follow-up. Conclusion: Although effective for gastric cancer, sintilimab may rarely induce life-threatening TEN. Early recognition, immediate ICI withdrawal, and coordinated multidisciplinary care are pivotal to survival. This case highlights the importance of early recognition, immediate discontinuation of ICIs, and coordinated multidisciplinary management in patients who develop life-threatening cutaneous immune-related adverse events. Further multicenter studies are needed to clarify mechanisms and risk factors of ICI-associated TEN.
Keywords: gastric cancer, Immune checkpoint inhibitor, Immune-related adverse event, multidisciplinary management, PD-1 inhibitor, Sintilimab, Stevens–Johnson syndrome, toxic epidermal necrolysis
Received: 19 Dec 2025; Accepted: 13 Feb 2026.
Copyright: © 2026 Zhao, Cao, Zou, Wang, Yu, Zhang, Wang and Miao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Zhang
Li-Na Wang
Yandong Miao
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.