Pneumonitis and concomitant bacterial pneumonia in patients receiving pembrolizumab treatment: Three case reports and literature review

Jiho Jun, Sang Ryung Lee, Ji Yean Lee, Min Joo Choi, Ji Yun Noh, Hee-Jin Cheong, Woo Joo Kim, Joon-Young Song

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Abstract

RATIONALE: Pembrolizumab, a monoclonal antibody against the programmed cell death 1 (PD-1) protein, can induce a stable regression of some malignancies refractory to conventional chemotherapy. Despite such therapeutic benefits, pembrolizumab can induce immune-related adverse events, with pneumonitis being the most critical problem. PATIENT CONCERNS: All 3 patients complained of fever, cough, and dyspnea after a variable time interval (1-21 days) from pembrolizumab treatment. DIAGNOSES: Chest computed tomography invariably showed ground glass opacity. All tests for possible infectious agents were negative. Based on high procalcitonin level, one of 3 patients was diagnosed to have accompanying bacterial pneumonia. INTERVENTIONS: All patients received antibiotics and steroid treatments (methylprednisolone, 1 mg/kg). OUTCOMES: The 3 patients showed different clinical courses ranging from mild pneumonitis to rapidly progressing respiratory failure. Among the 3 patients, 2 fully recovered with steroid treatment; 1 died from superimposed bacterial pneumonia. LESSONS: The prognosis of pembrolizumab-induced pneumonitis with a superimposed bacterial pneumonia would be poor. It is important to distinguish pure pneumonitis from that with a superimposed bacterial pneumonia.

Original languageEnglish
Pages (from-to)e16158
JournalMedicine
Volume98
Issue number25
DOIs
Publication statusPublished - 2019 Jun 1

Fingerprint

Bacterial Pneumonia
Pneumonia
Programmed Cell Death 1 Receptor
Steroids
Therapeutics
Methylprednisolone
Calcitonin
Cough
Respiratory Insufficiency
Dyspnea
Glass
Fever
Thorax
Monoclonal Antibodies
Tomography
pembrolizumab
Anti-Bacterial Agents
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pneumonitis and concomitant bacterial pneumonia in patients receiving pembrolizumab treatment : Three case reports and literature review. / Jun, Jiho; Lee, Sang Ryung; Lee, Ji Yean; Choi, Min Joo; Noh, Ji Yun; Cheong, Hee-Jin; Kim, Woo Joo; Song, Joon-Young.

In: Medicine, Vol. 98, No. 25, 01.06.2019, p. e16158.

Research output: Contribution to journalArticle

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