CASE REPORT article
Front. Pharmacol.
Sec. Pharmacology of Anti-Cancer Drugs
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1619450
Immune-Related Eruptive Keratoacanthoma with Fungal Coinfection Under PD-1 Inhibitor Therapy: A Diagnostic and Therapeutic Challenge
Provisionally accepted
- 1Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, shanghai, China
- 2Ningbo Hangzhou Bay Hospital, ningbo, China
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Background: It has been reported that immunotherapy with programmed cell death protein 1 (PD-1) inhibitors (pembrolizumab or nivolumab) can induce multiple eruptive keratoacanthomas (KAs) representing an immune-related cutaneous adverse event (ircAE).Methods: This case report describes a 63-year-old female with recurrent cervical adenocarcinoma who developed multiple eruptive KAs and concurrent fungal infection following treatment with the PD-1 inhibitor zimberelimab. We analyzed the etiology, diagnosis and treatment by integrating clinical manifestations, pathological examinations, previous treatment history and literature research.Results: Despite initial misdiagnosis as a fungal infection, multidisciplinary review identified KA as an ircAE. Topical corticosteroids led to resolution, and another PD-1 inhibitor was reintroduced without recurrence of cutaneous toxicity.This is the first documented case of eruptive KA linked to zimberelimab, expanding the spectrum of PD-1 inhibitor-associated ircAEs. Concurrent fungal infection obscured the diagnosis, delaying appropriate treatment, highlighting the importance of recognizing rare ircAEs and multidisciplinary collaboration.
Keywords: Immune checkpoint inhibitors (ICIs), Programmed cell death protein 1 (PD-1), Immune-related adverse event (irAE), immune-related cutaneous adverse event (ircAE), Eruptive keratoacanthomas
Received: 28 Apr 2025; Accepted: 25 Jul 2025.
Copyright: © 2025 Su, Wu, Hou, Yan, Ma and Lin. 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: Xiumei Ma, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, shanghai, China
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