Lovly CM, Boyd KL, Gonzalez-Ericsson PI, Lowe CL, Brown HM, Hoffman RD, Sterling BC, Kapp ME, Johnson DB, Kopparapu PR, Iams WT, Warren MA, Noto MJ, Rini BI, Jagasia M, Das SR, Balko JM. Rapidly fatal pneumonitis from immunotherapy and concurrent SARS-CoV-2 infection in a patient with newly diagnosed lung cancer. MedRxiv : the preprint server for health sciences. 2020 May 1. PMID: 32511636 [PubMed] PMCID: PMC7276992
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.