Severe cutaneous adverse reaction following COVID‐19 vaccination and immunotherapy: a second hit?
Dear Editor, A 62-year-old female with metastatic melanoma presented with shortness of breath four days after her fourth cycle of combination checkpoint inhibitor therapy (CPI) (nivolumab and ipilimumab) having previously received 12 months of adjuvant nivolumab 14 months earlier. Subsequent investigations confirmed CPI related myocarditis. She also described new onset of symptoms consistent with Raynaud's. Her past medical history included recurrent migraines for which she took propranolol. She was admitted to hospital, and received two 500mg doses of intravenous methylprednisolone, and commenced on a reducing course or oral prednisolone (1mg/kg), lansoprazole and co-trimoxazole prophylaxis. Blood tests initially revealed a negative anti-nuclear antibody, lupus anticoagulant and anticardiolipin antibodies with normal complement levels and rheumatoid factor. However repeat bloods six weeks later revealed a positive ANA and a very mildly positive extractable nuclear antigen (anti-SSA52/Ro autoantibody) by rheumatology did not identify any underlying connective tissue disease and concluded that the Raynaud's was likely to be secondary to the CPI.