Helber Henrique Alkalay, Hada Aline Lury, Pio Raquel Baptista, Moraes Pedro Henrique Zavarize de, Gomes Diogo Bugano Diniz
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2018 Jun 21;16(2):eRC4030. doi: 10.1590/S1679-45082018RC4030.
Immunotherapy-induced pneumonitis is a rare complication with incidence estimated around 3%. This disease is difficult to diagnose and has great morbidity. For this reason, it became a challenge for oncologists and emergencists. We reviewed the case of five patients who used anti-PD1 (program cell death receptor antagonist 1) for antineoplastic treatment and developed treatment-induced pneumonitis. All patients had respiratory problems because of immunotherapy and presence of ground-glass radiologic change. Among all patients, only one had grade 5 pneumonitis, and delaying to begin corticosteroid therapy and worsening in clinical picture led to patient death. Other four patients with symptomatic grade 2 pneumonitis underwent corticosteroid therapy and had improvement in clinical and radiologic picture. Two patients were treated after an episode of pneumonitis, and no new pulmonary complications were observed until the end of this study. Immunotherapy-induced pneumonitis, although uncommon, can be potentially fatal. Medical team has the responsibility to pay attention for most common symptoms of the disease such as cough and dyspnea and conduct an early diagnosis and effective early treatment with corticosteroids.
免疫疗法诱发的肺炎是一种罕见的并发症，发病率估计约为3%。这种疾病难以诊断，且发病率很高。因此，它对肿瘤学家和急诊医生来说是一项挑战。我们回顾了5例使用抗PD1（程序性细胞死亡受体拮抗剂1）进行抗肿瘤治疗并发生治疗诱发肺炎的患者病例。所有患者均因免疫疗法出现呼吸问题，并伴有磨玻璃样影像学改变。在所有患者中，只有1例发生5级肺炎，延迟开始使用皮质类固醇治疗以及临床症状恶化导致患者死亡。其他4例有症状的2级肺炎患者接受了皮质类固醇治疗，临床和影像学表现均有改善。2例患者在肺炎发作后接受治疗，直至本研究结束均未观察到新的肺部并发症。免疫疗法诱发的肺炎虽然不常见，但可能会致命。医疗团队有责任关注该疾病的最常见症状，如咳嗽和呼吸困难，并进行早期诊断，以及使用皮质类固醇进行有效的早期治疗。
