The medical records and the imaging studies of these patients were retrospectively reviewed with approval from the institutional review board.CT ndings of pneumonitis were evaluated for distributions in terms of lobar involvement; and specic CT ndings including traction bronchiectasis, consolidation, reticular opacities, groundglass opacities. In each case, radiographic patterns of pneumonitis were classied according to the ATSERS international multidisciplinary classication of interstitial pneumonias as pattern, acute respiratory distress syndrome not applicable, as described previously. Followup chest imaging studies after the onset of pneumonitis were also reviewed to assess the resolution of the ndings.Clinical presentations, the treatment regimen for pneumonitis, and the clinical course were obtained from the medical records.Thirteen of these patients; patients received nivolumab monotherapy, and patients received XY1 combination therapy. Ten patients had melanoma, had lymphoma, and had lung cancer, including with NSCLC and with smallcell lung cancer had received chest radiotherapy prior to PD inhibitor therapy.The extent of lung Flunisolide involvement by pneumonitis was highest in the lower lungs, followed by the middle lungs, and was lowest in the upper lungs, with a median extent score of for the upper lungs.The most common distribution of CT ndings of pneumonitis was mixed and multifocal, all lobes of the lung, including the lingula, were involved.Pneumonitis in lung cancer patients had more extensive involvement on CT than others. Nivolumab therapy was held at the time of pneumonitis in all patients.The majority of the patients received corticosteroids as a treatment for pneumonitis.Three patients also received iniximab in addition to corticosteroids.Three patients received no corticosteroids for pneumonitis; of these, one patient was on hydrocortisone mg daily for adrenal insufciency that had been previously diagnosed.Seven patients were admitted to the hospital for treatment of pneumonitis, including patients with melanoma and all patients with lung cancer.Two of the melanoma patients were admitted to the ICU, and patient required intubation during ICU admission.During the treatment and followup course, patients with grade or above had clinical and radiographic improvement, and patients with grade pneumonitis without symptoms had radiographic improvement.One patient with grade pneumonitis started the next systemic therapy without further followup CT.One patient was referred to hospice care without followup CT and passed away.Nivolumab therapy was restarted in patients, including patients with melanoma and patients with lymphoma; of these patients, had a COP pattern and had an NSIP pattern.One patient received nivolumab monotherapy and had received combination therapy at the time of pneumonitis.During retreatment, patients received nivolumab monotherapy including patients who restarted on maintenance monotherapy after the initial doses of the combination regimen, and patients restarted combination therapy. Among the patients with retreatment, recurrent pneumonitis was noted in patients.Spectrum of radiographic manifestations of PD inhibitorrelated pneumonitis.One of the involved areas in the left lower lobe demonstrated a reversed halo sign with central GGO surrounded by dense airspace consolidation of crescentic shape, which has been reported as a radiographic manifestation of COP.Note that the consolidations and interlobular septal thickening in the right lung demonstrate tumor involvement by lung cancer, which were present since the baseline scan.A C E G B D F H monotherapy, and developed recurrent pneumonitis after doses of nivolumab, which was successfully treated with corticosteroid taper without further nivolumab retreatment or recurrence for months after the second episode.

Leave a Reply