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Allergic bronchopulmonary aspergillosis presumably unmasked by PD-1 inhibition
  1. Anthony A Donato1 and
  2. Ronald Krol2
  1. 1 Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA
  2. 2 Pulmonary and Critical Care, Tower Health System, West Reading, Pennsylvania, USA
  1. Correspondence to Dr Anthony A Donato, anthony.donato{at}


Programmed cell death-1 (PD-1) inhibitors stimulate immune recognition of tumour cells in cancer patients, but have significant autoimmune side effects including pneumonitis. We report the case of a patient with asthma and mild eosinophilia who developed unusual pulmonary side effect of bronchiectasis, severe eosinophilia (absolute eosinophil count: 3200 c/mm3) and elevated IgE levels (7050 IU/mL; normal: <164 IU/mL) 4 months into therapy with the PD-1 inhibitor pembrolizumab. Aspergillus fumigatus IgG was elevated at 15.60 U/mL (normal: <12.01 U/mL). He responded to therapy with corticosteroids and voriconazole and was able to resume pembrolizumab thereafter with good clinical response.

  • lung cancer (oncology)
  • unwanted effects / adverse reactions
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  • Contributors AAD and RK both had access to all of the data, contributed significantly to the manuscript and the final editing of the paper.

  • 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.

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