Divisions of Oncology.
Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Hematol Oncol. 2021 Mar 1;43(2):e163-e164. doi: 10.1097/MPH.0000000000001757.
We describe a case of Pneumocystis jirovecii pneumonia in an 18-year-old female individual with refractory primary mediastinal B-cell lymphoma treated with the immune checkpoint inhibitor pembrolizumab. She received 11 doses of pembrolizumab without immune-related adverse events (irAEs) before the diagnosis of P. jirovecii pneumonia. However, prophylactic trimethoprim/sulfamethoxazole was discontinued 6 months of postautologous stem cell transplant per standard guidelines. This case report highlights the importance of judicious infectious disease evaluation while on immune checkpoint inhibitor therapy as symptoms can often mimic irAEs. Furthermore, the benefits of immunosuppressive therapy for the treatment of presumptive irAEs must be weighed against the possible increased risk for opportunistic infections.
我们描述了一例原发性纵隔 B 细胞淋巴瘤患者在接受免疫检查点抑制剂派姆单抗治疗时发生肺囊虫肺炎的病例。该患者在诊断为肺囊虫肺炎之前，已接受了 11 剂派姆单抗治疗，未出现免疫相关不良事件（irAEs）。然而，根据标准指南，在自体干细胞移植后 6 个月停用了预防性复方磺胺甲噁唑。本病例报告强调了在接受免疫检查点抑制剂治疗时进行谨慎的传染病评估的重要性，因为症状常与 irAEs 相似。此外，在权衡免疫抑制治疗对疑似 irAEs 的治疗益处时，必须考虑到机会性感染风险增加的可能性。
