Rapidly fatal pneumonitis from immunotherapy and concurrent SARS-CoV-2 infection in a patient with newly diagnosed lung cancer
Lovly, C. M.; Boyd, K. L.; Gonzalez-Ericsson, P. I.; Lowe, C. L.; Brown, H. M.; Hoffman, R. D.; Sterling, B. C.; Kapp, M. E.; Johnson, D. B.; Kopparapu, P. R.; Iams, W. T.; Warren, M. A.; Noto, M. J.; Rini, B. I.; Jagasia, M.; Das, S. R.; Balko, J. M.
Show abstract
Immune checkpoint inhibitors (ICIs) are used for the treatment of numerous cancers, but risks associated with ICI-therapy during the COVID-19 pandemic are poorly understood. We report a case of acute lung injury in a lung cancer patient initially treated for ICI-pneumonitis and later found to have concurrent SARS-CoV-2 infection. Post-mortem analyses revealed diffuse alveolar damage in both the acute and organizing phases, with a predominantly CD68+ inflammatory infiltrate. Serum was positive for anti-SARS-CoV-2 IgG, suggesting that viral infection predated administration of ICI-therapy and may have contributed to a more fulminant clinical presentation. These data suggest the need for routine SARS-CoV-2 testing in cancer patients, where clinical and radiographic evaluations may be non-specific.
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