Rapidly fatal pneumonitis from immunotherapy and concurrent SARS-CoV-2 infection in a patient with newly diagnosed lung cancer.
Christine M LovlyKelli L BoydPaula I Gonzalez-EricssonCindy L LoweHunter M BrownRobert D HoffmanBrent C SterlingMeghan E KappDouglas B JohnsonPrasad R KopparapuWade T IamsMelissa A WarrenMichael J NotoBrian I RiniMadan JagasiaSuman R DasJustin M BalkoPublished in: medRxiv : the preprint server for health sciences (2020)
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.
Keyphrases
- sars cov
- respiratory syndrome coronavirus
- newly diagnosed
- liver failure
- case report
- oxidative stress
- locally advanced
- interstitial lung disease
- radiation therapy
- single cell
- rheumatoid arthritis
- hepatitis b virus
- combination therapy
- respiratory failure
- young adults
- machine learning
- systemic sclerosis
- african american
- human health
- chemotherapy induced