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Case Report: Pembrolizumab-associated airway-predominant relapsing polychondritis with longitudinal CD8+ T-cell activation and bronchial stenting

Year: 2026

Type: article

Abstract: Immune checkpoint inhibitors (ICIs) can trigger autoimmune and autoinflammatory toxicities through disruption of peripheral immune tolerance. Relapsing polychondritis (RP) after programmed cell death protein 1 (PD-1) blockade is rare and are described mainly in individual reports. We report a 66-year-old man who developed severe airway-predominant RP after 10 cycles of pembrolizumab for lung adenocarcinoma. Chest CT showed new diffuse tracheal and bilateral bronchial wall thickening and calcification, with severe obstructive ventilatory impairment and systemic inflammation. Exploratory serial peripheral-blood immunophenotyping demonstrated increased proportions of CD38+ and HLA-DR+ cells among circulating CD8+ T cells early in the disease course. Serial measurements showed lower activated CD8+ T-cell proportions during immunosuppressive treatment, in parallel with partial stabilization of respiratory symptoms, pulmonary function and imaging. The patient received sequential glucocorticoids, tofacitinib, methotrexate, abatacept and tocilizumab. Despite partial inflammatory control, subsequent pulmonary infection with severe coughing was followed by pneumomediastinum and progressive structural airway compromise requiring bilateral main-bronchial stenting. One year after stenting, the stents remained in situ with no obvious luminal stenosis and pulmonary function remained stable. This case extends the reported spectrum of pembrolizumab-associated RP by documenting an airway-predominant, treatment refractory course with serial immune phenotyping and long-term post-stenting follow-up.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1999620