BMJ Case Reports 2018; doi:10.1136/bcr-2018-225937
  • Unexpected outcome (positive or negative) including adverse drug reactions

Severe pneumonitis refractory to steroids following anti-PD-1 immunotherapy

  1. Vishesh Paul3
  1. 1Internal Medicine, College of Medicine, University of Illinois, Urbana, Illinois, USA
  2. 2Hematology & Oncology, Carle Foundation Hospital, Urbana, Illinois, USA
  3. 3Pulmonology & Critical Care, Carle Foundation Hospital, Urbana, Illinois, USA
  1. Correspondence to Dr Neal Andruska, nandrus2{at}, nandrus59{at}
  • Accepted 12 September 2018
  • Published 8 October 2018


Anti-programmed death 1 (PD-1) immune checkpoint inhibitors enhance the antitumour activity of the immune system and have produced durable tumour responses in several solid tumours including non-small cell lung cancer (NSCLC). However, PD-1 inhibitors can lead to immune-related adverse events , including pneumonitis, which is typically mild, but can be severe and potentially fatal. Pneumonitis often resolves with steroids, but some cases are steroid refractory, leading to a relapsing and remitting course in milder cases or the need for salvage therapies in more severe cases. Here, we present two patients with NSCLC who developed severe pneumonitis following therapy with nivolumab and pembrolizumab. While one patient improved with steroids and infliximab, the other patient failed to respond to steroids and subsequently died. These cases demonstrate the highly variable presentation and therapeutic responses seen in patients with pneumonitis following anti-PD-1 therapy and illustrate that severe cases can often present refractory to steroid therapy.


  • Contributors NA, LM, CH, PP and VP were involved in the care of patients, data acquisition and interpretation, and drafting of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article