Division of Oncology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China.
J Med Case Rep. 2021 Feb 1;15(1):41. doi: 10.1186/s13256-020-02619-y.
Pneumonitis belongs to the fatal toxicities of anti-PD-1/PD-L1 treatments. Its diagnosis is based on immunotherapeutic histories, clinical symptoms, and the computed tomography (CT) imaging. The radiological features were typically ground-glass opacities, similar to CT presentation of 2019 Novel Coronavirus (COVID-19) pneumonia. Thus, clinicians are cautious in differential diagnosis especially in COVID-19 epidemic areas.
Herein, we report a 67-year-old Han Chinese male patient presenting with dyspnea and normal body temperature on the 15th day of close contact with his son, who returned from Wuhan. He was diagnosed as advanced non-small cell lung cancer and developed pneumonitis post Sintilimab injection during COIVD-19 pandemic period. The chest CT indicated peripherally subpleural lattice opacities at the inferior right lung lobe and bilateral thoracic effusion. The swab samples were taken twice within 72 hours and real-time reverse-transcription polymerase-chain-reaction (RT-PCR) results were COVID-19 negative. The patient was thereafter treated with prednisolone and antibiotics for over 2 weeks. The suspicious lesion has almost absorbed according to CT imaging, consistent with prominently falling CRP level. The anti-PD-1 related pneumonitis mixed with bacterial infection was clinically diagnosed based on the laboratory and radiological evidences and good response to the prednisolone and antibiotics.
The anti-PD-1 related pneumonitis and COVID-19 pneumonia possess similar clinical presentations and CT imaging features. Therefore, differential diagnosis depends on the epidemiological and immunotherapy histories, RT-PCR tests. The response to glucocorticoid is still controversial but helpful for the diagnosis.
肺炎是抗 PD-1/PD-L1 治疗的致命毒性之一。其诊断基于免疫治疗史、临床症状和计算机断层扫描（CT）成像。放射学特征通常为磨玻璃样混浊，类似于 2019 年新型冠状病毒（COVID-19）肺炎的 CT 表现。因此，临床医生在鉴别诊断时特别谨慎，尤其是在 COVID-19 流行地区。
在此，我们报告了一名 67 岁的汉族男性患者，与从武汉返回的儿子密切接触 15 天后出现呼吸困难和正常体温。他被诊断为晚期非小细胞肺癌，并在 COVID-19 大流行期间接受 Sintilimab 注射后发生肺炎。胸部 CT 显示右下肺外周胸膜下网格状混浊和双侧胸腔积液。在 72 小时内采集了两次拭子样本，实时逆转录聚合酶链反应（RT-PCR）结果均为 COVID-19 阴性。此后，患者接受泼尼松龙和抗生素治疗超过 2 周。根据 CT 成像，可疑病变几乎吸收，与 CRP 水平明显下降一致。根据实验室和影像学证据以及对泼尼松龙和抗生素的良好反应，临床诊断为抗 PD-1 相关肺炎合并细菌感染。
抗 PD-1 相关肺炎和 COVID-19 肺炎具有相似的临床表现和 CT 成像特征。因此，鉴别诊断取决于流行病学和免疫治疗史、RT-PCR 检测。糖皮质激素的反应仍存在争议，但有助于诊断。
