{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:46:34Z","timestamp":1790027194664,"version":"4.0.1"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,1,23]],"date-time":"2017-01-23T00:00:00Z","timestamp":1485129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cutan Pathol"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Nivolumab is a programmed cell death receptor\u20101 (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\u20101) antibody used in the treatment of metastatic or unresectable melanoma. Cutaneous reactions are the most common adverse events reported with these agents and are rarely severe or life\u2010threatening. Here we present a case report describing the clinicopathological findings of a patient with a fatal toxic epidermal necrolysis (<jats:styled-content style=\"fixed-case\">TEN<\/jats:styled-content>) eruption associated with use of nivolumab for treatment of metastatic melanoma. The patient developed a pruritic, morbiliform eruption, which slowly progressed over 3 months to a tender, exfoliative dermatosis. Histology initially showed interface dermatitis and subsequently revealed full thickness epidermal necrosis. The diagnosis of <jats:styled-content style=\"fixed-case\">TEN<\/jats:styled-content> was made. From initial biopsy to <jats:styled-content style=\"fixed-case\">TEN<\/jats:styled-content> presentation, there was an increase in the number of <jats:styled-content style=\"fixed-case\">CD8<\/jats:styled-content>+ lymphocytes within the dermal\u2013epidermal junction and an increase of programmed death ligand 1 (<jats:styled-content style=\"fixed-case\">PD\u2010L1<\/jats:styled-content>) expression in both lymphocytes and keratinocytes. Despite treatment with infliximab, high\u2010dose steroids and intravenous immunoglobulin, the patient expired. Herein we describe what we believe is the second case of <jats:styled-content style=\"fixed-case\">TEN<\/jats:styled-content> associated with anti\u2010<jats:styled-content style=\"fixed-case\">PD1<\/jats:styled-content> therapy reported in the literature. Increased expression of <jats:styled-content style=\"fixed-case\">PD\u2010L1<\/jats:styled-content> by immunohistochemistry was observed as the eruption progressed to <jats:styled-content style=\"fixed-case\">TEN<\/jats:styled-content>. Early diagnosis and treatment is necessary in these fatal <jats:styled-content style=\"fixed-case\">TEN<\/jats:styled-content> reactions secondary to the anti\u2010<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\u20101 antibody therapies.<\/jats:p>","DOI":"10.1111\/cup.12876","type":"journal-article","created":{"date-parts":[[2016,12,21]],"date-time":"2016-12-21T06:22:41Z","timestamp":1482301361000},"page":"381-384","source":"Crossref","is-referenced-by-count":110,"title":["Epidermal programmed cell death\u2010ligand 1 expression in <scp>TEN<\/scp> associated with nivolumab therapy"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1434-6638","authenticated-orcid":false,"given":"Karina L.","family":"Vivar","sequence":"first","affiliation":[{"name":"Department of Dermatology and Cutaneous Surgery University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Deschaine","sequence":"additional","affiliation":[{"name":"Anatomic Pathology Moffitt Cancer Center  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Messina","sequence":"additional","affiliation":[{"name":"Anatomic Pathology Moffitt Cancer Center  Tampa Florida"},{"name":"Departments of Dermatology and Pathology and Cell Biology University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Divine","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Cutaneous Surgery University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Rabionet","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Cutaneous Surgery University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishit","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Cutaneous Surgery University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic Surgery University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6004-2451","authenticated-orcid":false,"given":"Lucia","family":"Seminario\u2010Vidal","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Cutaneous Surgery University of South Florida  Tampa Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,1,23]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.02.010"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.02.025"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.5210"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2016.2226"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2016.02.003"},{"key":"e_1_2_4_7_1","unstructured":"CF Friedman TA Proverbs\u2010Singh Treatment of the immune\u2010related adverse effects of immune checkpoint inhibitors"},{"key":"e_1_2_4_8_1","first-page":"179","article-title":"Immunoregulatory role of B7\u2010H1 in chronicity of inflammatory response","volume":"3","author":"Dong H","year":"2006","journal-title":"Cell Mol 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