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CASE REPORT
Immunotherapy causing pneumonitis in a patient with non-small cell lung cancer (NSCLC)
  1. Rui Li1,
  2. Gina Lee1,2 and
  3. Ahmed El-Sherief3,4
  1. 1 Pulmonary Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
  2. 2 Pulmonary and Critical Care Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
  3. 3 Radiology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA
  4. 4 Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Gina Lee, gina.lee{at}va.gov

Abstract

Our patient, who had been previously diagnosed with non-small cell lung cancer, presented with progressive dyspnoea after receiving second-line immunotherapy treatment with atezolizumab. Chest CT scan showed bilateral lung architectural distortion, bronchial dilatation, consolidative opacities, ground-glass opacities and linear opacities concerning for either infectious lung disease or treatment-related lung disease. A diagnostic bronchoscopy was performed and no evidence of malignancy or infection was detected. Discontinuing atezolizumab with the addition of oral corticosteroid improved the patient’s respiratory symptoms but the patient required continuous oxygen supplementation. Later, the patient was found to have radiologic findings suggestive of further progression of his pneumonitis after completion of a course of corticosteroid treatment and required another course of oral prednisone. Immune-mediated pneumonitis could present with mild to severe respiratory symptoms with a wide range of clinical and radiologic features and physicians should be aware of this diagnosis of exclusion. Although patients may experience progressive disease with or without immunotherapy rechallenge, most of these cases can be managed successfully with favourable outcomes.

  • tobacco-related disease
  • lung cancer (oncology)
  • malignant disease and immunosuppression
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Footnotes

  • Contributors RL wrote the summary, background and discussion sections. GL contributed to the summary, case presentation, differential diagnosis, treatment and discussion sections. AE-S contributed to the case presentation and discussion sections and provided the radiographic images and interpretations.

  • 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.

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

  • Patient consent for publication Obtained.

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