SHM Converge Scientific Abstract ePoster Gallery-The Double-Edge Sword: When Pd-1 Inhibitors Take More Than Cancer

Pdf Summary

This case report describes a rare but severe immune-related adverse event from immune checkpoint inhibitor (ICI) therapy: pneumonitis. ICIs such as nivolumab (PD-1 inhibitor) and ipilimumab (CTLA-4 inhibitor) have improved cancer outcomes by enhancing anti-tumor immunity, but they can also trigger potentially life-threatening inflammatory toxicities.<br /><br />The patient was a 63-year-old man with COPD, tobacco use, and metastatic renal cell carcinoma involving the lungs. Four weeks after starting nivolumab and ipilimumab, he developed diarrhea, chills, and rigor and was hospitalized for suspected ICI-related gastroenteritis. He improved on a steroid taper, but after finishing the taper, he returned with worsening shortness of breath, dry cough, and low-grade fever.<br /><br />On presentation, he was febrile, tachycardic, tachypneic, and severely hypoxic, requiring BiPAP and vasopressors. Infectious evaluation was broadly negative, including respiratory viral testing, SARS-CoV-2, blood and respiratory cultures, and testing for several fungal and bacterial pathogens. Chest CT showed new bilateral upper-lobe ground-glass opacities and interstitial changes suspicious for pneumonitis. Because of high concern for immune-related pneumonitis, he was treated with broad-spectrum antibiotics and high-dose IV steroids. He initially improved, but later worsened with progressive hypoxemia and was transitioned to comfort care. He ultimately died from grade 5 pneumonitis.<br /><br />The report highlights key clinical lessons: ICI-induced pneumonitis can occur at any point during treatment or even after therapy has stopped, symptoms may mimic infection, and prompt recognition is critical. Corticosteroids are the mainstay of treatment, usually with a slow taper to prevent relapse. Clinicians should maintain a low threshold to suspect pneumonitis in any ICI-treated patient with dyspnea, cough, or fever.

Asset Subtitle

Eddie Khav

Meta Tag

Author List Eddie Khav, Neychelle Rocca

Category Clinical Vignettes

Concept Immune Checkpoint Inhibitor

Concept Immune-Related Adverse Event

Concept Pneumonitis

Concept Glucocorticoid Therapy

Concept PD-1 Inhibitor

Distinguished Non-Finalist

Presenter Organization Verde Valley Medical Center Internal Medicine Residency Program

Presenting Author Eddie Khav

Track Adult

Keywords

immune checkpoint inhibitor

pneumonitis

nivolumab

ipilimumab

immune-related adverse event

metastatic renal cell carcinoma

corticosteroids

ground-glass opacities

hypoxemia

case report

Immune Checkpoint Inhibitor

Immune-Related Adverse Event

Pneumonitis

Glucocorticoid Therapy

PD-1 Inhibitor