# Sintilimab-induced toxic epidermal necrolysis complicated in advanced gastric cancer: a case report and literature review

## TL;DR

A rare but severe skin reaction called toxic epidermal necrolysis occurred in a patient treated with sintilimab for advanced gastric cancer, emphasizing the need for early recognition and multidisciplinary care.

## Contribution

This case report is one of the few documenting sintilimab-induced toxic epidermal necrolysis and highlights successful multidisciplinary management strategies.

## Key findings

- A patient with advanced gastric cancer developed life-threatening toxic epidermal necrolysis after sintilimab treatment.
- Multidisciplinary care, including immunoglobulin and corticosteroids, led to full recovery from the severe skin reaction.
- Early recognition and discontinuation of sintilimab were critical for the patient's survival.

## Abstract

Immune checkpoint inhibitors (ICIs) can trigger immune-related adverse events (irAEs), among which Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is exceptionally rare but potentially fatal. Sintilimab, a PD-1 inhibitor increasingly used for advanced gastric cancer, has only sporadically been linked to SJS/TEN.

We report a 60-year-old man with metastatic gastric adenocarcinoma who developed TEN 7 days after the first sintilimab infusion. He presented with rapidly progressive diffuse erythema, bullae, and epidermal detachment involving >90% of the body surface area, accompanied by fever and upper gastrointestinal bleeding leading to hemodynamic instability.

Sintilimab was permanently discontinued. Multidisciplinary management was initiated, including intensive fluid and electrolyte resuscitation, high-dose intravenous immunoglobulin, systemic corticosteroids with careful bleeding surveillance, specialized burn-type wound care, tailored anti-infective therapy based on susceptibility testing, and aggressive nutritional support. This case report was prepared in accordance with the CARE (CAse REport) guidelines.

Skin lesions gradually re-epithelialized, infection was controlled, and gastrointestinal bleeding stabilized. The patient fully recovered from TEN and was discharged on hospital day 32. No recurrence or secondary infection was observed on follow-up.

Although effective for gastric cancer, sintilimab may rarely induce life-threatening TEN. Early recognition, immediate ICI withdrawal, and coordinated multidisciplinary care are pivotal to survival. This case highlights the importance of early recognition, immediate discontinuation of ICIs, and coordinated multidisciplinary management in patients who develop life-threatening cutaneous immune-related adverse events.