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This report describes a 69-years-old male with recurrent hypopharyngeal cancer who experienced only recurrent Grade 1 maculopapular rash during treatment with tislelizumab combined with chemotherapy and subsequent maintenance therapy. However, within 2 days after switching to pembrolizumab, his condition deteriorated rapidly into TEN, involving over 95% of the body surface area and multiple mucosal sites including the oral cavity and conjunctivae. Skin biopsy revealed epidermal necrosis, subepidermal clefts, and infiltration of CD4 and CD8 positive T lymphocytes. Immunohistochemistry demonstrated positive PD-L1 expression but negative PD-1 expression. These pathological findings suggested that alterations in the local cutaneous immune microenvironment following sequential administration of different PD-1 inhibitors might play a critical role in the fulminant progression of TEN.<\/jats:p>","DOI":"10.3389\/fmed.2026.1789285","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:39:53Z","timestamp":1779082793000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapid progression to toxic epidermal necrolysis following switch of PD-1 inhibitors: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Meiling","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Radiotherapy, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou","place":["Zhejiang, China"]},{"name":"Department of Radiotherapy, Huzhou Central Hospital, Fifth Affiliated Clinical Medical College of Zhejiang 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