{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:03:34Z","timestamp":1783454614031,"version":"3.55.0"},"reference-count":10,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Dermatology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Acquired idiopathic generalized anhidrosis (AIGA) is a rare disorder of sweating that can be life\u2010threatening owing to the risk of heat stroke. AIGA as an immune\u2010related adverse event (irAE) of immune checkpoint inhibitors (ICIs) has been reported in only three cases. We report a 69\u2010year\u2010old man with unresectable lung adenocarcinoma (cT1N2M1b, Stage 4A) with hepatic metastasis who developed generalized anhidrosis after approximately 2\u2009years (30\u2009cycles) of pembrolizumab monotherapy. EGFR, ALK, and ROS1 were negative, and programmed death\u2010ligand 1 (PD\u2010L1) tumor proportion score (TPS; 22C3 antibody) was 90%\u2013100%. Sweat testing revealed anhidrosis exceeding 75% of the body surface. Acetylcholine injection testing indicated idiopathic pure sudomotor failure (IPSF)\u2010type dysfunction. Skin biopsy revealed site\u2010dependent findings: peri\u2010eccrine lymphocytic infiltration involving the sweat glands and ducts in the sweating area (axilla) and prominent peri\u2010eccrine fibrosis in the anhidrotic area (left forearm). Serum carcinoembryonic antigen (CEA) was elevated to 16.7\u2009ng\/mL without tumor progression, prompting diagnostic workup including colonoscopy, which revealed no abnormalities. The patient was treated with three courses of methylprednisolone pulse therapy (1000\u2009mg\/day \u00d7\u20093\u2009days) over 7\u2009months and fexofenadine, resulting in partial sweating recovery and CEA decline to 3.0\u2009ng\/mL. Pembrolizumab was continued throughout without interruption, and the patient maintained durable stable disease (SD) over approximately 45\u2009months (alive at last follow\u2010up). This case demonstrates the histopathological spectrum of ICI\u2010induced AIGA from inflammation to fibrosis within a single patient, and highlights CEA elevation as both a diagnostic clue and a potential pitfall in oncological practice.<\/jats:p>","DOI":"10.1111\/1346-8138.70306","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T07:01:13Z","timestamp":1778482873000},"page":"1072-1076","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acquired Idiopathic Generalized Anhidrosis as a Late\u2010Onset Immune\u2010Related Adverse Event of Pembrolizumab in a Patient With Lung Adenocarcinoma: A Case Report and Review of the Literature"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2519-8378","authenticated-orcid":false,"given":"Ayano","family":"Maruyama","sequence":"first","affiliation":[{"name":"Department of Dermatology, Graduate School of Medical Science Kyoto Prefectural University of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayaka","family":"Sotozono","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Graduate School of Medical Science Kyoto Prefectural University of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0364-711X","authenticated-orcid":false,"given":"Takeshi","family":"Fukumoto","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Graduate School of Medical Science Kyoto Prefectural University of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.13649"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22168389"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1703481"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-017-0336-3"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2217\/imt-2020-0002"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14967"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.17361"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdermsci.2022.10.001"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.19284"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14443"}],"container-title":["The Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1346-8138.70306","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1346-8138.70306","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1346-8138.70306","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:46:40Z","timestamp":1783450000000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1346-8138.70306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":10,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/1346-8138.70306"],"URL":"https:\/\/doi.org\/10.1111\/1346-8138.70306","archive":["Portico"],"relation":{},"ISSN":["0385-2407","1346-8138"],"issn-type":[{"value":"0385-2407","type":"print"},{"value":"1346-8138","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"assertion":[{"value":"2026-02-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}