Radiologic and autopsy findings in a case of fatal immune checkpoint inhibitor-associated pneumonitis

Oncologists are increasingly managing drug-induced pneumonitis in lung cancer patients treated with PD-1/PD-L1 immune checkpoint inhibitors. To date only few studies on the topic have described both radiologic and pathologic findings in these patients. Here, we report a fatal case of immune checkpoint inhibitor-associated pneumonitis initially presenting with an organizing pneumonia, but who rapidly developed acute respiratory distress syndrome (confirmed histologically at the time of autopsy). As such, this case illustrates the need for clinicians to maintain a high index of suspicion for immune checkpoint inhibitor associated pneumonitis and have a low threshold to perform CT imaging in any symptomatic patient receiving checkpoint inhibition therapy.Clinical practice points
- Pneumonitis is a rare but potentially fatal complication of immune checkpoint inhibitors.
- Variety of radiographic and histopathologic patterns have been seen in immune checkpoint inhibitor-associated pneumonitis.
- Clinicians must maintain a high index of suspicion and have a low threshold to perform CT imaging in any symptomatic patient receiving checkpoint inhibition therapy.