Hall Philip, Miller Catherine, Ahmad Arsalan, Akl Karim, Litinski Mikhail
Internal Medicine, Bayonne Medical Center, Bayonne, USA.
Pulmonary and Critical Care Medicine, Jersey City Medical Center, Jersey City, USA.
Cureus. 2025 Jul 2;17(7):e87150. doi: 10.7759/cureus.87150. eCollection 2025 Jul.
Immune checkpoint inhibitors like pembrolizumab have transformed oncology but carry the risk of immune-related adverse events (irAE), including pneumonitis. We report a case of a 66-year-old male with multiple cardiac comorbidities who presented with acute hypoxic respiratory failure two months after discontinuing pembrolizumab due to repeated respiratory complaints. Imaging showed bilateral infiltrates and ground-glass opacities; infectious workup was negative. He was treated with corticosteroids for combined pembrolizumab-induced pneumonitis and diuretics for concurrent chronic heart failure exacerbation. Symptoms improved with supportive care and immunotherapy suspension. This case highlights the diagnostic challenge of differentiating irAE pneumonitis from infection or congestive heart failure (CHF) and underscores the need for early recognition in high-risk patients.
像帕博利珠单抗这样的免疫检查点抑制剂已经改变了肿瘤学，但存在免疫相关不良事件（irAE）的风险，包括肺炎。我们报告了一例66岁男性，有多种心脏合并症，在因反复呼吸问题停用帕博利珠单抗两个月后出现急性缺氧性呼吸衰竭。影像学显示双侧浸润和磨玻璃影；感染相关检查结果为阴性。他接受了皮质类固醇治疗以应对帕博利珠单抗诱发的肺炎，并使用利尿剂治疗同时并发的慢性心力衰竭加重。通过支持治疗和暂停免疫治疗，症状有所改善。该病例突出了区分irAE肺炎与感染或充血性心力衰竭（CHF）的诊断挑战，并强调了高危患者早期识别的必要性。
