Immune-related pneumonia induced by nivolumab

A 68-year-old male patient with lung adenocarcinoma and bone and adrenal metastasis received an IV infusion of nivolumab 180 mg (on day 1 of each chemotherapy cycle of 14 days), and completed 3 cycles in total. On day 70 after the first infusion, the patient developed fever, cough with sputum, and dyspnea. The above symptoms aggravated gradually despite oxygen and anti-infective treatment for 3 days. Blood gas analysis indicated type I respiratory failure. Ground glass opacities and reticular opacities in bilateral lungs were found in the chest CT. Considering the immune-related pneumonia complicated by infection induced by nivolumab, high-dose methylprednisolone was given to inhibit the immune response, meropenem and voriconazole were given to prevent infection, and oxygen and expectorants were given as the symptomatic and supportive treatments. Finally the symptoms of the patient gradually relieved. Key words: Pneumonia; Lung diseases, interstitial; Antineoplastic agents; Programmed cell death 1 receptor; Immunity; Nivolumab