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Early presentation of pembrolizumab-associated pneumonitis
  1. Joshua Christy,
  2. Abdul Rafae,
  3. Emad Kandah and
  4. Arvind Kunadi
  1. Internal Medicine, McLaren Regional Medical Center, Flint, Michigan, USA
  1. Correspondence to Dr Joshua Christy; joshua.christy{at}


Pembrolizumab is a selective anti-PD-L1 humanised monoclonal antibody approved by the Food and Drug Administration for treating multiple cancers, including cervical cancer, non-small cell lung cancer (NSCLC), renal cell carcinoma, bladder cancer, and squamous head and neck cancer. Pneumonitis is a rare but known complication of pembrolizumab treatment for NSCLC. The median time frame of its appearance is 2.8 months. However, we present a case of pneumonitis appearing within 48 hours. The patient presented with rapidly progressive respiratory failure, and imaging demonstrated diffuse bilateral patchy involvement of the upper lung lobe and pre-hilar regions, which likely indicate pneumonitis. Because of likely grade 3 pneumonitis, he was treated with steroids and showed immediate improvement of symptoms. Repeated CT imaging showed resolution of bilateral patchy infiltrates. He was discharged to the rehabilitation unit. Rapid recognition of pneumonitis as a side effect of pembrolizumab is important because early treatment can help prevent respiratory failure and possible death.

  • lung cancer (oncology)
  • chemotherapy
  • immunology
  • unwanted effects / adverse reactions
  • pharmacology and therapeutics

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  • Contributors JC, AR and EK conceived the idea of writing the case report. JC, AR and EK did the literature search. All authors discussed the literature findings and contributed to the final manuscript. JC, AR and EK wrote the manuscript with support from AK. AK supervised the project. All authors reviewed, discussed and provided critical feedback to the final 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.

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