Li Rui, Lee Gina, El-Sherief Ahmed
Pulmonary Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
Pulmonary and Critical Care Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, USA.
BMJ Case Rep. 2019 Mar 4;12(3):e226044. doi: 10.1136/bcr-2018-226044.
Our patient, who had been previously diagnosed with non-small cell lung cancer, presented with progressive dyspnoea after receiving second-line immunotherapy treatment with atezolizumab. Chest CT scan showed bilateral lung architectural distortion, bronchial dilatation, consolidative opacities, ground-glass opacities and linear opacities concerning for either infectious lung disease or treatment-related lung disease. A diagnostic bronchoscopy was performed and no evidence of malignancy or infection was detected. Discontinuing atezolizumab with the addition of oral corticosteroid improved the patient's respiratory symptoms but the patient required continuous oxygen supplementation. Later, the patient was found to have radiologic findings suggestive of further progression of his pneumonitis after completion of a course of corticosteroid treatment and required another course of oral prednisone. Immune-mediated pneumonitis could present with mild to severe respiratory symptoms with a wide range of clinical and radiologic features and physicians should be aware of this diagnosis of exclusion. Although patients may experience progressive disease with or without immunotherapy rechallenge, most of these cases can be managed successfully with favourable outcomes.
我们的患者先前被诊断为非小细胞肺癌，在接受阿替利珠单抗二线免疫治疗后出现进行性呼吸困难。胸部CT扫描显示双侧肺结构扭曲、支气管扩张、实变影、磨玻璃影和线状影，考虑为感染性肺病或治疗相关肺病。进行了诊断性支气管镜检查，未发现恶性肿瘤或感染的证据。停用阿替利珠单抗并加用口服糖皮质激素改善了患者的呼吸道症状，但患者仍需要持续吸氧。后来，在完成一个疗程的糖皮质激素治疗后，发现患者的影像学表现提示其肺炎进一步进展，需要再进行一个疗程的口服泼尼松治疗。免疫介导的肺炎可表现为轻度至重度呼吸道症状，具有广泛的临床和影像学特征，医生应意识到这种排除性诊断。尽管患者在再次接受或不接受免疫治疗时可能会出现疾病进展，但大多数此类病例可以成功管理并取得良好结果。
