Title:A “Crazy Paving” Pattern on CT Scan in a Patient Treated with Pembrolizumab
VOLUME: 14 ISSUE: 3
Author(s):Maurizio Marvisi*, Sara Ramponi, Laura Balzarini and Chiara Mancini
Affiliation:Depertment of Internal Medicine, Istituto Figlie di San Camillo, Cremona, Depertment of Internal Medicine, Istituto Figlie di San Camillo, Cremona, Depertment of Internal Medicine, Istituto Figlie di San Camillo, Cremona, Depertment of Internal Medicine, Istituto Figlie di San Camillo, Cremona
Keywords:Pembrolizimab, PD-1 inhibitors, pulmonary toxicity, pneumonitis, NSCLC, ICIs, HRCT.
Abstract:
Background: Programmed cell death protein 1 (PD-1) and its ligand, PD-L1, have
shown great promise in clinical practice and have been incorporated into standard management of
NSCLC. Pneumonitis is a serious autoimmune toxicity associated with the use of anti-PD-1/PD-L1
antibodies, resulting in significant morbidity and mortality.
Methods: We described the case of a 73-year-old woman with no history of smoking developing
exertional dyspnea four months after taking Pembrolizumab.
Results: High resolution contrast CT scan (HRCT) presented a unilateral “crazy paving” pattern,
and bronchoalveolar lavage (BAL) an important lymphocytosis (20% of total cell count). The patient
reached clinical stability after the administration of systemic steroids (2mg\Kg\die) and was
discharged with long term oxygen therapy.
Discussion: Pulmonary toxicity is frequent when using PD-1 inhibitors, resulting in significant
morbidity and mortality, often leading to the discontinuation of therapy. Clinical presentation is
usually protean and HRCT pattern is nonspecific. This is the first case presenting a “crazy paving”
pattern associated with BAL lymphocytosis.
Conclusion: Oncologists, pulmonologists, radiologists and general practitioners have to consider
PD-1 and PD-L1 inhibitor pneumonitis as a potentially disabling and fatal event.
