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Linear IgA Disease of the Gingiva Following Nivolumab Therapy

Jonna, Sushma*; Neiders, Mirdza†,‡; Lakshmanan, Suresh†,‡; Khan, Amir§; DeKlotz, Timothy; Lanasa, Dominic*; Gibney, Geoffrey T.*; Liu, Stephen V.*

doi: 10.1097/CJI.0000000000000288
Clinical Studies

Immunotherapy has advanced the treatment of solid organ malignancies. Although generally well tolerated, treatment with immune checkpoint inhibitors can be complicated by immune-related adverse events, some of which are relatively uncommon. We report the first case of gingival linear immunoglobulin A disease related to treatment with an antiprogrammed cell death protein 1 antibody. A 73-year-old male with advanced non–small cell lung cancer achieved a durable response to nivolumab monotherapy. After 1 year of treatment, he developed gingival swelling and pain. Biopsy revealed linear immunoglobulin A disease of the gingiva which was effectively treated with systemic steroids. Ongoing vigilance for immune-mediated toxicity is paramount during and after treatment with immune checkpoint inhibitors.

*Department of Medicine, Lombardi Comprehensive Cancer Center

Department of Otolaryngology, Georgetown University, Washington, DC

Department of Oral Diagnostic Sciences, State University of New York at Buffalo

Immco Diagnostics Inc., Buffalo, NY

§MedStar St. Mary’s Hospital, Leonardtown, MD

The present study was conducted in accordance with all accepted standards for the ethical conduct of human subjects research.

The patient provided written informed consent for photographs and publication.

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

S.J. and S.V.L.: contributed to the conception, design, data collection, data interpretation, and writing of this manuscript. S.V.L.: is one of the treating oncologists for this case and is the corresponding author. M.N. and S.L.: are the pathologists who reviewed this case; they provided direct immunofluorescence images and contributed to manuscript writing. A.K.: is one of the treating oncologists for this case and provided critical edits to the manuscript. T.D.: is the treating otolaryngologist for this case and provided critical edits to the manuscript. G.T.G.: reviewed and edited the manuscript. D.L.: created and formatted the images. All authors contributed to and approved the final manuscript.

Reprints: Stephen V. Liu, MedStar Georgetown University Hospital, Lombardi Comprehensive Cancer Center, 3800 Reservoir Road NW, Washington, DC 20007 (e-mail:

Received February 5, 2019

Accepted May 21, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.