Immune checkpoint inhibitor-related pneumonitis with atypical radiologic features in a patient with anti-aminoacyl-tRNA synthetase antibody

Respir Med Case Rep. 2022 Dec 15:41:101797. doi: 10.1016/j.rmcr.2022.101797. eCollection 2023.

Abstract

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.

Keywords: ALK, anaplastic lymphoma kinase; ANAs, anti-nuclear antibodies; ARS, aminoacyl tRNA synthetases; ASS, anti-synthetase syndrome; Anti-aminoacyl-tRNA synthetase antibody; CTCAE, common terminology criteria for adverse events; EGFR, epidermal growth factor receptor; GGO, ground-glass opacity; HP, hypersensitivity pneumonitis; HRCT, high-resolution computed tomography; ICIs, immune checkpoint inhibitors; IIM, idiopathic inflammatory myopathy; ILD, interstitial lung disease; Immune checkpoint inhibitor; NSCLC, non-small-cell lung cancer; NSIP, nonspecific interstitial pneumonia; Non-small-cell lung cancer; OP, organizing pneumonia; OS, overall survival; PD-1, programmed cell death-1; PD-L1, programmed cell death-ligand-1; PFS, progression-free survival; Pneumonitis; RR, response rate; UIP, usual interstitial pneumonia; irAEs, immune-related adverse events.

Publication types

  • Case Reports