Abstract
Immune checkpoint inhibitors have revolutionized the therapies of malignancies. The adverse effects caused by these inhibitors known as immune related adverse events (irAEs) are common and can be serious. Cutaneous side effects, affecting up to a quarter of the patients, commonly manifest as maculopapular rashes with pruritus. Grover’s disease is among the frequently encountered irAEs. Here we present a 56-year-old female who was referred to dermatology clinic for a pruritic rash. The patient is inflicted with an undifferentiated autoimmune disorder consisting of interstitial lung disease, gastroparesis, myalgia, fatigue, and arthropathy, dating back to 11 years ago. The disease was preceded by a severe episode of flu. The patient has been on a variety of immunosuppressants including HCQ 200 mg daily, CellCept 1000 mg BID, and rofimulast 500 mcg daily. Additionally, she has been enrolled in a clinical trial for Tezepelumab for eight months. 1-2 days each time after Tezepelumab was injected, she develops a red, scaly rash between her breasts, on her lateral chest bilaterally, and most recently, on left eye and left temple, exacerbated by heat. The injections are typically given in her right or left arms. The redness of the rash lasts around 2 weeks before fading and leaving a scaly texture behind. Triamcinolone cream shows no effect on the rash. Patient has no known history of rashes previously. A biopsy of her rash revealed papular acantholytic dermatosis, compatible with Grover's disease. To our knowledge, this is the first case of Tezepelumab induced Grover’s disease-like eruption.