Abstract：
BACKGROUND: Immune checkpoint inhibitors (ICIs) are a promising new treatment for different types of cancer. The infectious complications in patients taking ICIs are rare.
METHODS: A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy.
CONCLUSIONS: Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.
METHODS: A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy.
CONCLUSIONS: Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.
摘要：
背景：免疫检查点抑制剂（ICIs）是用于不同类型癌症的有希望的新疗法。服用ICIs的患者的感染并发症很少见。
方法：一名58岁男性，一个月前接受了由pembrolizumab（PD-1抑制剂）组成的食管鳞状细胞癌化疗，在纤维支气管镜检查后不久因呼吸急促入院，这是为了检查下气道。胸部计算机断层扫描显示右上叶进行性巩固。D组沙门菌分离于支气管肺泡灌洗(BAL)液培养。同一临床样品的真菌培养产生了黑曲霉；此外，在患者的BAL液和血清中均发现了高滴度的曲霉抗原（高于临界值）。尽管抗菌治疗的有效范围和适当剂量，患者死于弥散性血管内凝血病.
结论：了解ICI治疗后肺炎的病因中的异常病原体可能有助于避免诊断不足。
方法：一名58岁男性，一个月前接受了由pembrolizumab（PD-1抑制剂）组成的食管鳞状细胞癌化疗，在纤维支气管镜检查后不久因呼吸急促入院，这是为了检查下气道。胸部计算机断层扫描显示右上叶进行性巩固。D组沙门菌分离于支气管肺泡灌洗(BAL)液培养。同一临床样品的真菌培养产生了黑曲霉；此外，在患者的BAL液和血清中均发现了高滴度的曲霉抗原（高于临界值）。尽管抗菌治疗的有效范围和适当剂量，患者死于弥散性血管内凝血病.
结论：了解ICI治疗后肺炎的病因中的异常病原体可能有助于避免诊断不足。
