Diffuse pneumonitis from coronavirus HKU1 on checkpoint inhibitor therapy

BackgroundImmune checkpoint inhibitors (ICIs) can produce specific immune-related adverse events including pneumonitis. The impact of ICI therapy on the severity of acute coronavirus infection symptomatology warrants further exploration.Case presentationWe report a 65-year-old man diagnosed with sta...

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Bibliographic Details
Published in:Journal for immunotherapy of cancer 2020-05, Vol.8 (1), p.e000898
Main Authors: Serzan, Michael T, Kumar, Princy N, Atkins, Michael B
Format: Article
Language:English
Subjects:
Antigens
Cancer
Case Report
case reports
Coronaviruses
COVID-19
Dyspnea
FDA approval
immunomodulation
Immunotherapy
Infections
Medical imaging
Melanoma
Metabolism
Metastasis
Middle East respiratory syndrome
Mortality
Patients
Respiratory diseases
Severe acute respiratory syndrome coronavirus 2
Steroids
Viral infections
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Summary:BackgroundImmune checkpoint inhibitors (ICIs) can produce specific immune-related adverse events including pneumonitis. The impact of ICI therapy on the severity of acute coronavirus infection symptomatology warrants further exploration.Case presentationWe report a 65-year-old man diagnosed with stage IV melanoma who developed pulmonary and brain metastases and was treated with bilateral craniotomies followed by combined nivolumab and ipilimumab immunotherapy. He developed early-onset severe dyspnea associated with acute coronavirus HKU1 (non-COVID-19) infection, with diffuse pneumonitis evidenced by ground glass opacification on CT scan. He was treated with steroids leading to resolution of pneumonitis on repeat imaging, suggesting an exacerbated immune-mediated toxicity.ConclusionWe report the first case of a patient with melanoma with severe and reversible diffuse pneumonitis in association with coronavirus HKU1 following combined nivolumab and ipilimumab immunotherapy. Although we do not have data on the impact of ICI therapy on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptomatology, a possible interaction should be considered when deciding on dosing in patients with possible SARS-CoV-2 exposure or when evaluating patients with presumed ICI-related pneumonitis during the COVID-19 pandemic.
ISSN:2051-1426
2051-1426
DOI:10.1136/jitc-2020-000898