A case of generalized pustular psoriasis induced by targeted immune combined therapy in primary hepatocellular carcinoma with literature review
原发性肝癌靶免联合治疗诱发泛发性脓疱型银屑病1例并文献复习

摘要

我国原发性肝癌发病率居高不下，靶向联合免疫治疗已成为中晚期患者的重要手段，皮肤毒性是其较常见不良反应。银屑病为多因素介导的慢性炎症性皮肤病，在抗肿瘤药物作用下易急性加重。本文报告1例47岁男性中国肝癌分期（CNLC）Ⅱb期肝癌患者，合并慢性乙肝、肝硬化及十余年寻常型银屑病，经导管动脉化疗栓塞术+肝动脉灌注化疗（TACE+HAIC）联合多纳非尼、替雷利珠单抗治疗后，稳定期银屑病迅速进展为泛发性脓疱型银屑病。结合病史、影像、检验及专科会诊确诊为靶免治疗诱发泛发性脓疱型银屑病。经停药、抗炎、护肝及皮肤综合处理后症状改善。文章结合病例与文献，分析其临床特点、发病机制、鉴别要点及分级处理方案。

Abstract

The incidence rate of primary liver cancer in China remains persistently high. Targeted combined immunotherapy has become a crucial treatment for patients in the intermediate and advanced stages, with cutaneous toxicity being a relatively common adverse reaction. Psoriasis is a chronic inflammatory skin disease mediated by multiple factors and is prone to acute exacerbation under the influence of antitumor drugs. This report presents a case of a 47-year-old male patient with stage IIb liver cancer (China Liver Cancer Staging (CNLC) classification), who also had chronic hepatitis B, cirrhosis, and psoriasis vulgaris lasting over a decade. After treatment with Transcatheter Arterial Chemoembolization +Hepatic Arterial Infusion Chemotherapy (TACE+HAIC) combined with donafenib and toripalimab, his stable-phase psoriasis rapidly progressed to generalized pustular psoriasis. Based on medical history, imaging, laboratory tests, and specialist consultations, the diagnosis of generalized pustular psoriasis induced by targeted-immunotherapy was confirmed. Symptoms improved following drug discontinuation, anti-inflammatory therapy, liver protection, and comprehensive skin management. The article analyzes the clinical features, pathogenesis, key differentials, and graded treatment strategies by combining this case with relevant literature.