Serplulimab-induced toxic epidermal necrolysis-like reaction in a patient with extensive-stage small-cell lung cancer: a case report and literature review

Background Serplulimab is the first anti-PD-1 monoclonal antibody to receive marketing approval for the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC) worldwide. To date, only sporadic cases of immune-induced adverse events (irAEs) secondary to serplulimab have been reported. Herein, we report a case of a man who suffered from a toxic epidermal necrolysis-like reaction after treatment with serplulimab and was successfully treated with comprehensive therapy. Additionally, we review the literature on toxic epidermal necrolysis (TEN) associated with serplulimab and provide a detailed description of the clinical symptoms, underlying mechanisms, and treatment for a more comprehensive understanding of immune-related TEN for the first time. Case summary A 76-year-old man diagnosed with ES-SCLC developed sporadic red maculopapular eruptions 7 days after the first cycle of serplulimab infusion, which rapidly progressed to blisters and ulceration, ultimately deteriorating to extensive epidermal detachment within a short time. A diagnosis of a TEN-like reaction was conservatively made due to the lack of a skin biopsy. The patient was successfully treated with a multifaceted management approach consisting of immune suppression using a combination of corticosteroids and intravenous immunoglobulin (IVIG), anti-infection treatment based on susceptibility testing, personalized wound care, and nutritional support. Conclusion Despite serplulimab having reshaped the treatment landscape of ES-SCLC, the occurrence of rare but potentially fatal TEN secondary to serplulimab should not be ignored. This case illustrates that serplulimab can induce a rare but potentially fatal TEN-like reaction within a short time and underscores the importance of vigilant monitoring of skin and mucous membranes and early recognition during treatment. In addition, we highlight that a multidimensional treatment approach consisting of immune suppression, anti-infection treatment, wound care, and nutritional support is pivotal for recovery.