Track: Case Reports

Abstract:

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapy that engineers autologous T-cells to target malignant cells by binding tumor-specific antigens. While highly effective in hematologic malignancies, CAR-T therapy is associated with unique toxicities, including cutaneous reactions that remain incompletely characterized. We report the case of a 68-year-old man with refractory high-grade diffuse large B-cell lymphoma who received axicabtagene ciloleucel CAR-T therapy. On day 6 post-infusion, he developed a widespread erythematous rash accompanied by pruritus and burning. This presentation coincided with fevers and hypotension, and an infectious workup was negative. The constellation of systemic symptoms was attributed to cytokine release syndrome (CRS). Skin biopsy revealed a vacuolar interface dermatitis with numerous dyskeratotic keratinocytes, which are histopathologic features closely resembling graft-versus-host disease (GVHD). However, the patient had no history of hematopoietic stem cell transplantation. Given the clinical context and pathology, a diagnosis of CRS-associated cutaneous eruption was favored. The patient received tocilizumab and topical steroids with ultimate resolution in systemic and cutaneous symptoms. This case highlights a newly recognized entity: CRS-related skin eruption with histopathologic mimicry of GVHD in the setting of CAR-T therapy. Awareness of this presentation is essential to avoid misdiagnosis and to broaden the spectrum of known CAR-T-associated cutaneous toxicities.

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Ryan Murphy