Fatal early-onset checkpoint inhibitor pneumonitis in a patient with advanced squamous-cell lung cancer with underlying pulmonary fibrosis: a case report and review of the literature
Year: 2025
Type: article
Study design: Case Report
Abstract: Introduction: We report a case of fulminant checkpoint inhibitor pneumonitis (CIP) occurring after a single dose of immune checkpoint inhibitor (ICI) therapy in a patient with advanced non-small cell lung cancer and underlying fibrotic interstitial lung disease (ILD), illustrating a rare but clinically significant and often fatal immune-related adverse event. Main symptoms and clinical findings: A 78-year-old woman with stage IVb squamous-cell carcinoma of the lung and idiopathic pulmonary fibrosis (IPF) developed progressive dyspnea, hypoxemia, and systemic inflammation shortly after receiving her first dose of pembrolizumab. High-resolution computed tomography (HRCT) revealed new bilateral ground-glass opacities superimposed on a fibrotic background with a definite usual interstitial pneumonia (UIP) pattern. Diagnoses interventions and outcomes: Fulminant early-onset CIP was diagnosed after exclusion of infectious causes. Despite discontinuation of immunotherapy and escalation of immunosuppressive treatment-including high-dose corticosteroids, mycophenolate mofetil, and infliximab-the patient's respiratory status deteriorated, resulting in death 27 days after treatment initiation. Conclusion: This case illustrates that life-threatening CIP can occur after a single dose of ICI in patients with fibrotic ILD. It emphasizes the urgent need for risk-adapted treatment strategies and enhanced monitoring protocols in this high-risk population.
Source: Frontiers in Oncology
Institution: Poznan University of Medical Sciences
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W4415835858