Ichihara Seiya, Ogino Hirokazu, Yoneda Hiroto, Haji Keiko, Kagawa Kozo, Murakami Kojin, Mima Masato, Aoi Yu, Mitsuhashi Atsushi, Tsukazaki Yuki, Yabuki Yohei, Ozaki Ryohiko, Sato Seidai, Nokihara Hiroshi, Nishioka Yasuhiko
Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Respir Med Case Rep. 2022 Dec 15;41:101797. doi: 10.1016/j.rmcr.2022.101797. eCollection 2023.
A man with non-small-cell lung cancer who was negative for anti-nuclear antibodies was admitted for dyspnea after immune checkpoint inhibitor (ICI) administration. Computed tomography (CT) showed complexed radiologic features, including subpleural and basal predominant reticular shadow with cystic structures and peribronchovascular consolidation. Although we treated him with high-dose steroid under a diagnosis of ICI-related pneumonitis, he developed acute exacerbation of pneumonitis with progressive fibrosis and volume loss. A re-evaluation identified anti-aminoacyl-tRNA synthetase antibody in the serum collected before ICI administration. This case highlights the importance of re-evaluating pre-existing autoimmune disorders in patients who develop ICI-related pneumonitis with atypical radiologic features.
一名抗核抗体阴性的非小细胞肺癌男性患者在接受免疫检查点抑制剂（ICI）治疗后因呼吸困难入院。计算机断层扫描（CT）显示出复杂的影像学特征，包括以胸膜下和肺底部为主的网状阴影伴囊性结构以及支气管血管周围实变。尽管我们在诊断为ICI相关性肺炎的情况下用大剂量类固醇对他进行了治疗，但他仍出现了肺炎急性加重，伴有进行性纤维化和肺容积减少。重新评估发现在ICI给药前采集的血清中有抗氨酰tRNA合成酶抗体。该病例强调了对出现具有非典型影像学特征的ICI相关性肺炎的患者重新评估既往自身免疫性疾病的重要性。
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