Focal lung infiltrate complicating PD-1 inhibitor use: A new pattern of drug-associated lung toxicity?
A 58-year-old woman with stage 4 adenocarcinoma of the lung being treated with pembrolizumab developed dyspnea, non-productive cough, and a right middle lobe infiltrate. Complete resolution of the infiltrate with cessation of pembrolizumab, initiation of prednisone and no antibiotic therapy suggested drug-associated lung toxicity as the cause. While the programmed death-1 (PD-1) inhibitors -pembrolizumab and nivolumab - have been implicated as a cause of diffuse or multifocal pulmonary infiltrates, the current case represents, to our knowledge, the first instance of a unilobar, focal infiltrate associated with their use. We speculate that the blockade of immune tolerance that is the hallmark of PD-1 inhibitors might cause atypical inflammatory reactions such as the focal lobar infiltrate seen in the current patient. Awareness of this novel radiographic pattern of drug-associated lung toxicity may enhance clinicians' management of patients receiving.
Respiratory Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Sameep
S
Sehgal
Tausig Cancer Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
Vamsidhar
V
Velcheti
Department of Pathology, Cleveland Clinic, Cleveland, OH, 44195, USA.
Sanjay
S
Mukhopadhyay
Education Institute, Respiratory Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
James K
JK
Stoller
Drug toxicity; Lung cancer; Nivolumab; PD-1 inhibitors; Pembrolizumab
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