Anti–PD-1-induced bullous pemphigoid in a renal transplant recipient
Bibliographic record
Abstract
Immune checkpoint inhibitors, particularly anti-PD-1 agents, are increasingly associated with bullous pemphigoid, a rare yet significant immune-related adverse event. We report a case of immune checkpoint inhibitor-induced bullous pemphigoid in a 74-year-old renal transplant recipient undergoing cemiplimab and later pembrolizumab for recurrent cutaneous squamous cell carcinomas. Bullous pemphigoid developed 23 months after initial immune checkpoint inhibitor exposure and 4 weeks after pembrolizumab reinitiation, presenting with generalized pruritus and tense bullae. Diagnosis was confirmed by histology and direct immunofluorescence. Disease was managed with oral prednisone and topical steroids, with relapses occurring upon tapering. This case highlights the complex interplay between immune checkpoint inhibitors, transplant immunosuppression, and autoimmune toxicity, underscoring the need for personalized, multidisciplinary management strategies in transplant patients receiving immune checkpoint inhibitors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".