Day 0
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1st dose of pembrolizumab (No symptoms)
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At 25 weeks
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Raynaud’s like symptoms (Patient started on nifedipine)
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At 27 weeks
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No resolution of Raynaud’s symptoms and persistence of cyanosis (Patient started on prednisone)
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At 29 weeks
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Development of dry gangrene at fingertips bilaterally
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At 33 weeks
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Extension of necrosis and development of ulceration. Patient still on pembrolizumab. Sympathectomy performed (patient still on nifedipine and glucocorticoids)
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At 37 weeks
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Tumor progression (pembrolizumab stopped). Extension of the necrosis stopped after week 37
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