Very pleased to close out 2022 with the opportunity to share important clinical lessons from a case just published in @BrownHospMed:
"Unilateral Pneumonitis and Hydropneumothorax Following Pembrolizumab" 🫁 💊
Case report available here: bhm.scholasticahq.com
"Unilateral Pneumonitis and Hydropneumothorax Following Pembrolizumab" 🫁 💊
Case report available here: bhm.scholasticahq.com
Many thanks to @YaleIMed's Drs. Harriet Kluger & @PeterKahnMD for both their active involvement in this case & their support of this write-up.
Additionally, thankful to have had @yalepathology's Dr. Christine Minerowicz provide invaluable input on the pathology of this case.
Additionally, thankful to have had @yalepathology's Dr. Christine Minerowicz provide invaluable input on the pathology of this case.
Teaching points:
🔥 Immune checkpoint inhibitor (ICI) pneumonitis has an estimated incidence rate of ~2-5% & can occur at any time during immunotherapy
🔥 Common presenting symptoms include dyspnea (53%) & cough (35%). Notably, fever (12%) & chest pain (7%) are less common
🔥 Immune checkpoint inhibitor (ICI) pneumonitis has an estimated incidence rate of ~2-5% & can occur at any time during immunotherapy
🔥 Common presenting symptoms include dyspnea (53%) & cough (35%). Notably, fever (12%) & chest pain (7%) are less common
🫁 The radiographic presentation of ICI pneumonitis is quite diverse. On chest CT, findings similar to organizing pneumonia, NSIP, hypersensitivity pneumonitis, acute interstitial pneumonia, & sarcoid-like granulomatosis have all been described
Reference: bmccancer.biomedcentral.com
Reference: bmccancer.biomedcentral.com
🔴 Despite ↑ recognition that ICI pneumonitis can present unpredictably in temporality & chest radiography, focal/unilateral disease has rarely been reported
🔴 As a result, many clinicians only consider ICI pneumonitis in patients presenting w/ *bilateral* pulmonary disease
🔴 As a result, many clinicians only consider ICI pneumonitis in patients presenting w/ *bilateral* pulmonary disease
🫁 We describe a patient with highly dramatic, unilateral pneumonitis eventually resulting in hydropneumothorax, which responded to chest tube placement & prednisone
🚨 Given the high potential morbidity of untreated ICI pneumonitis, unusual radiographic features of ICI pneumonitis should be considered when assessing focal pulmonary infiltrates in patients on immune checkpoint inhibitors
📝 A detailed history noting the absence of fever, cough, & sputum production may be invaluable in differentiating unilateral ICI pneumonitis from bacterial pneumonia, as pneumonia biomarkers like CRP are non-specific & can be markedly elevated in ICI pneumonitis
🔬 On the other hand, the combination of a discordantly high CRP & low procalcitonin may be helpful in adjusting the DDx, as seen in this case (hs-CRP 183.5 mg/L, procalcitonin 0.08 ng/mL)
🏁 In conclusion, the lack of symmetry in pulmonary radiographic abnormalities should not rule out ICI pneumonitis as a possible etiology of pulmonary disease in patients on immune checkpoint inhibitors
🥂 Happy New Year! 🥂
Case report available here: bhm.scholasticahq.com
🥂 Happy New Year! 🥂
Case report available here: bhm.scholasticahq.com
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