Pembrolizumab Induced Grover-like Eruption in a Colorectal Liver Metastasis Patient: A Case Report and Review of Literature

Abstract

Background: Immune checkpoint inhibitors (ICIs) frequently induce immune-related adverse events (irAEs), including the rare cutaneous manifestation, transient acantholytic dermatosis (TAD), or Grover disease. Here, we detail a Grover-like eruption in a colorectal cancer patient on pembrolizumab and perform a review of the literature of this cutaneous irAE. Methods: PubMed was searched 3 times using the terms “immune checkpoint inhibitor AND grover” and “immune checkpoint inhibitor AND transient acantholytic dermatosis” and “immunotherapy AND transient acantholytic dermatosis”, yielding 30 results. After assessment of relevance, 8 articles remained and each of their references were examined for any possible missing articles, yielding an additional 3 articles, for a total of 11 studies. Results: Of the 16 reported TAD patients including our own, 75% are male, with ages ranging from 51 to 80 years old, and an average age of 68.3 years. The primary tumors included melanoma (56%), renal cell carcinoma (12.5%), non-small cell lung cancer (12.5%), among others. Most patients (50%) received PD-1 inhibitors, while 25% were on CTLA-4 inhibitors, and 25% were on combination anti-PD-1, anti-CTLA-4 therapy. While 69% of patients managed the eruption with prescribed therapy without discontinuing ICI, 62.5% required systemic steroid therapy for resolution. Conclusions: By optimizing the management of TAD and other cutaneous irAEs through collaborative care, providers can enhance the quality of life and treatment outcomes for individuals affected by TAD and other dermatological complications of cancer immunotherapy.