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

抗氨酰 - tRNA 合成酶抗体患者的免疫检查点抑制剂相关性肺炎具有非典型放射学特征.

• 发表时间: 2023
• 来源期刊: Respir Med Case Rep
• DOI: 10.1016/j.rmcr.2022.101797
• PMID: 36583061
• 文章类型: Case Reports
• 作者列表: Ichihara S,Ogino H,Yoneda H,Haji K,Kagawa K,Murakami K,Mima M,Aoi Y,Mitsuhashi A,Tsukazaki Y,Yabuki Y,Ozaki R,Sato S,Nokihara H,Nishioka Y

关键词: 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

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.

摘要

一名抗核抗体阴性的非小细胞肺癌患者在免疫检查点抑制剂（ICI）给药后因呼吸困难而入院。计算机断层扫描（CT）显示复杂的放射学特征，包括胸膜下和基底占优势的网状阴影，囊性结构和支气管血管周围巩固。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治疗他，患者出现肺炎急性加重,伴有进行性纤维化和体积减少.重新评估在ICI施用前收集的血清中鉴定了抗氨酰基-tRNA合成酶抗体。此病例强调了重新评估发生ICI相关性肺炎且具有非典型放射学特征的患者先前存在的自身免疫性疾病的重要性。