Allergic bronchopulmonary aspergillosis presumably unmasked by PD-1 inhibition

• Published in: BMJ case reports Vol. 12; no. 2; p. e227814
• Main Authors: Donato, Anthony A, Krol, Ronald
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2019; BMJ Publishing Group
• Series: Case Report
• Subjects: Adrenal Cortex Hormones - therapeutic use; Antibodies, Fungal - metabolism; Antibodies, Monoclonal, Humanized - adverse effects; Antifungal agents; Apoptosis; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary - chemically induced; Aspergillosis, Allergic Bronchopulmonary - diagnostic imaging; Aspergillosis, Allergic Bronchopulmonary - drug therapy; Aspergillosis, Allergic Bronchopulmonary - immunology; Aspergillus fumigatus - immunology; Asthma; Blood; Cancer therapies; Case reports; Dyspnea; Eosinophils - immunology; Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect; Food allergies; Fungal infections; Humans; Immune system; Immunotherapy; Lung cancer; Lung diseases; Male; Medical diagnosis; Metastasis; Middle Aged; Monoclonal antibodies; Patients; Pneumonia; Steroids; Systematic review; Targeted cancer therapy; Thyroid gland; Tomography, X-Ray Computed; Voriconazole - therapeutic use; unwanted effects / adverse reactions; lung cancer (oncology)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-227814

Programmed cell death-1 (PD-1) inhibitors stimulate immune recognition of tumour cells in cancer patients, but have significant autoimmune side effects including pneumonitis. We report the case of a patient with asthma and mild eosinophilia who developed unusual pulmonary side effect of bronchiectasis, severe eosinophilia (absolute eosinophil count: 3200 c/mm3) and elevated IgE levels (7050 IU/mL; normal: <164 IU/mL) 4 months into therapy with the PD-1 inhibitor pembrolizumab. Aspergillus fumigatus IgG was elevated at 15.60 U/mL (normal: <12.01 U/mL). He responded to therapy with corticosteroids and voriconazole and was able to resume pembrolizumab thereafter with good clinical response.