A 34-year-old male with metastatic penile squamous cell carcinoma presented with painful erosions, hemorrhagic crusting, and bullae involving his oral mucosa, sacrum, and left lower abdomen.患者在发作前五天完成了他的第二个ipilimumab/nivolumab的周期。实验室检查对于贫血和血小板病是显着的。呼吸道病原体面板，A组链球菌的喉培养和HSV/VZV拭子为阴性。Punch biopsy demonstrated vacuolar alteration of the basal cell layer with separation at the dermal epidermal junction and overlying full-thickness epidermal necrosis.口服泼尼松以0.5 mg/kg/day的给药开始，并导致显着改善。Given milder course with rapid improvement with oral steroids, lack of ocular involvement, and onset in the setting of immunotherapy, the diagnosis of progressive immunotherapy-related mucocutaneous eruption (PIRME) was made.PIRME is a recently described clinical entity of bullous mucocutaneous eruptions that are clinically and pathologically similar to Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) but occur in the setting of recent immunotherapy and typically follow a more indolent course.眼部受累很少见。In PIRME, some cases are thought to be triggered by a “second-hit” medication following priming of the immune system with initiation of immunotherapy, although in this case, we were unable to definitively identify a second culprit medication.鉴于我们患者的转移性疾病的进展，由于对Pirme的怀疑，该决定是将患者重新检查患者的ipilimumab/nivolumab。他成功地用ipilimumab/nivolumab重新开始治疗，而无需复发粘膜皮肤症状，目前正忍受他的第七个周期。