Stevens-Johnson syndrome/toxic epidermal necrolysis induced by sintilimab in a patient with advanced non-small cell lung cancer: A case report

RATIONALE: Sintilimab, an immune checkpoint inhibitor, enhances T-cell responses, leading to robust antitumor activity, and is approved for the treatment of lung cancer. While immune checkpoint inhibitors offer substantial clinical benefits, they are often associated with immune-related adverse events, particularly cutaneous toxicities. These skin reactions typically manifest as mild maculopapular rashes; however, more severe manifestations, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), can occur. Both SJS and TEN are life-threatening conditions with high mortality rates. PATIENT CONCERNS: The patient in this case is a 68-year-old male diagnosed with stage IVA non-small cell lung cancer, who has no detectable oncogenic mutations. He was treated with sintilimab (200 mg), pemetrexed disodium (500 mg/m2), and cisplatin (75 mg/m2). Following the third cycle of therapy, he developed widespread skin blisters, localized necrosis, and severe pain on the second day. DIAGNOSES: The patient's symptoms - widespread skin blisters, localized necrosis, and severe pain - were indicative of SJS and TEN, which are immune-related cutaneous toxicities triggered by immunotherapy. INTERVENTIONS: Immediate interventions were initiated, which included systemic corticosteroids, anti-inflammatory treatments, fluid replacement, and appropriate skin care measures. OUTCOMES: These interventions led to significant improvement in the immunotherapy-related dermatologic toxicity experienced by the patient. LESSONS: This case underscores the importance for clinicians to remain vigilant regarding severe cutaneous toxicities such as SJS and TEN in patients undergoing sintilimab-based therapy. Prompt recognition and intervention are essential to mitigate the risks associated with these potentially life-threatening conditions.