Stevens-Johnson syndrome/toxic epidermal necrolysis induced by tislelizumab: a case report and literature review

Tislelizumab, a programmed cell death-1 inhibitor approved for multiple malignancies, may induce Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)-a rare but potentially fatal severe drug eruption-and early effective intervention is pivotal for reducing SJS/TEN-related mortality. We describe an elderly male with hepatic malignancy who developed progressive SJS/TEN, involving over 80% of his total body surface area, after his first tislelizumab infusion. Conventional treatment with systemic corticosteroids combined with intravenous immunoglobulin was ineffective in halting disease progression. Subsequently, adjunctive therapy with a tumor necrosis factor-α (TNF-α) inhibitor and hemoperfusion was initiated, leading to the patient's eventual recovery. Managing SJS/TEN in patients with advanced malignancies poses substantial challenges, given the life-threatening nature of both entities. To our knowledge, this is the first reported case of using a TNF-α inhibitor for treating tislelizumab-induced SJS/TEN. This case highlights a novel, cost-effective, and well-tolerated therapeutic strategy that yielded favorable outcomes.