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Case report describes sintilimab-associated toxic epidermal necrolysis in gastric carcinoma patientRare Skin Reaction Follows Successful Stomach Cancer Therapy

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Key Takeaway
Recognize delayed toxic epidermal necrolysis risk with sintilimab in gastric cancer patients.

This publication is a case report focusing on a patient with gastric carcinoma treated with neoadjuvant sintilimab combined with the SOX regimen. The authors describe the occurrence of delayed-onset toxic epidermal necrolysis as a serious adverse event requiring discontinuation of immunotherapy. The report highlights the management of this immune-related cutaneous adverse event alongside oncologic outcomes in a single individual.

Key findings indicate the patient achieved a complete pathological response confirmed by postoperative pathology. Regarding safety, the patient experienced gradual recovery of skin lesions with no recurrence of toxic epidermal necrolysis during follow-up after receiving methylprednisolone. The authors note that sintilimab-induced toxic epidermal necrolysis can occur as a delayed immune-mediated reaction, even after drug discontinuation. This temporal relationship suggests a potential immune-mediated mechanism despite the delayed presentation.

The authors acknowledge significant limitations, specifically that this evidence stems from a single case report. Consequently, generalizability is restricted, and causal relationships cannot be definitively established from this isolated observation alone. The certainty of the evidence remains low due to the absence of comparative data or larger cohorts to validate the incidence rate.

Practice relevance emphasizes that early recognition and timely immunosuppressive treatment are essential for favorable outcomes in similar clinical scenarios. Clinicians should monitor patients closely for cutaneous toxicity when using sintilimab, though broader recommendations await higher-quality evidence. Awareness of this rare complication is necessary for managing patients on immune checkpoint inhibitors in gastric cancer settings. The authors highlight the need for vigilance regarding delayed immune-mediated reactions that may persist after drug discontinuation.

A Hopeful Moment Turns Worrisome

Imagine finishing cancer surgery feeling hopeful. You are ready to move forward with your life. Then, a rash spreads across your body. It starts on your back and moves to your arms and legs.

This is exactly what happened to a recent patient.

The patient had stomach cancer. They received a powerful drug called Sintilimab before surgery. The treatment worked well against the tumor. But a new problem appeared after the operation.

Immunotherapy drugs have changed how we treat many cancers. They help the body fight the disease on its own. These drugs are used for stomach cancer and many other types.

However, they can cause side effects. Most people know about fatigue or nausea. But skin reactions are less discussed.

Doctors usually expect side effects while the patient is taking the drug. This new case shows something different. The reaction happened after the treatment stopped.

The surprising timing shift

For years, doctors believed side effects happened during active treatment. They thought stopping the drug meant the risk was gone.

But here is the twist. This skin reaction appeared days after the surgery. It happened even though the patient had stopped the medication.

This changes how we watch for safety. It means the immune system can stay active for a while. It does not shut off immediately.

How the immune system reacts

To understand this, think of the immune system as a security guard. Its job is to find and stop bad cells. Sometimes, it gets too excited.

In this case, the guard attacked healthy skin cells. It confused them for cancer cells. This caused the skin to peel and blister.

Scientists call this an immune-related reaction. It happens when the body’s defense system goes into overdrive.

What the doctors saw

Researchers studied one specific patient with stomach cancer. They tracked the patient from the start of treatment. The patient took the drug for four cycles.

Then, they had surgery to remove the tumor. Everything looked good after the operation. The cancer was gone from the tissue.

But on the third day after surgery, a rash appeared. It started on the back and spread quickly.

This does not mean every patient will face this risk.

Doctors diagnosed the condition as toxic epidermal necrolysis. This is a severe skin reaction that needs care. The patient received steroid medicine to calm the immune system.

The skin lesions healed slowly. The patient recovered without the rash coming back.

If you are taking immunotherapy, talk to your doctor. Ask them about skin changes you might see. Do not ignore a new rash or blistering.

Early treatment helps prevent serious problems. Steroids and supportive care can manage the reaction.

It is also important to know that skin reactions can be a sign the drug is working. In some cases, strong immune activity helps fight the cancer.

But you should never try to cause a reaction. Always follow your medical team’s advice.

This report comes from a single patient. One person’s experience does not prove a rule for everyone.

We do not know how common this is yet. It is a rare event. More data is needed to understand the risk.

The path forward for research

Scientists need to learn more about this timing. Why does the reaction happen after the drug is stopped?

Researchers will study more patients to find patterns. They want to know who is at higher risk.

Future studies will look for ways to predict these reactions. This will help doctors protect patients better.

For now, the focus is on early detection. If you notice changes, report them immediately. This ensures the best possible outcome for your health.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
BackgroundSintilimab, a programmed death-1 (PD-1) inhibitor widely used in various malignancies, has demonstrated favorable antitumor efficacy and safety. However, severe immune-related cutaneous adverse events (irCAEs) such as toxic epidermal necrolysis (TEN) are rare but potentially fatal. Understanding their clinical characteristics, treatment strategies, and pathophysiological mechanisms is crucial for optimal management.Case presentationWe report a case of a patient with gastric carcinoma who developed delayed-onset TEN after receiving four cycles of neoadjuvant sintilimab combined with the SOX regimen (S-1 and oxaliplatin). The patient subsequently underwent radical gastrectomy, and postoperative pathology confirmed a complete pathological response. On the third postoperative day, the patient developed a scattered erythematous rash that began on the back and spread to the upper abdomen and upper and lower limbs, forming plaques. A dermatology consultation and clinical evaluation led to a diagnosis of immune-related TEN. The patient received systemic methylprednisolone and comprehensive supportive care, resulting in a gradual recovery of skin lesions, with no recurrence of TEN during follow-up.DiscussionThis case suggests that sintilimab-induced TEN can occur as a delayed immune-mediated reaction, even after drug discontinuation. The potential mechanism of sintilimab-induced TEN may involve the excessive activation of cytotoxic T lymphocytes and dysregulated immune responses leading to keratinocyte apoptosis through Fas/FasL and perforin–granzyme pathways. Notably, the occurrence of irCAEs has been associated with favorable antitumor responses in some patients, reflecting strong immune activation. Prompt discontinuation of immunotherapy, early initiation of high-dose corticosteroids, and supportive measures remain the cornerstone of management. TNF-α or JAK inhibitors may provide therapeutic benefit in refractory cases.ConclusionThis case highlights a rare instance of delayed-onset TEN following sintilimab-based neoadjuvant therapy in gastric cancer, occurring shortly after surgical resection despite a complete pathological response. Early recognition and timely immunosuppressive treatment are essential for favorable outcomes. Further investigation into the mechanisms and predictive factors of PD-1 inhibitor–induced TEN is warranted.
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