Concomitant Human Herpes Virus 6 and nivolumab-related pneumonitis: Potential pathogenetic insights

doi:10.1016/j.idcr.2018.01.013

Case Reports

. 2018 Feb 8:11:101-103.

doi: 10.1016/j.idcr.2018.01.013. eCollection 2018.

Concomitant Human Herpes Virus 6 and nivolumab-related pneumonitis: Potential pathogenetic insights

Periklis G Foukas¹, Sotirios Tsiodras², Panagiota Economopoulou³, Aris Spathis⁴, Maria Mademli⁵, Konstantinos Leventakos¹, Amanda Psyrri³, Petros Karakitsos⁴, Ioannis G Panayiotides¹

Affiliations

¹ 2nd Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
² 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
³ Medical Oncology Unit, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
⁴ Department of Cytopathology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
⁵ 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.

PMID: 29552493
PMCID: PMC5852387
DOI: 10.1016/j.idcr.2018.01.013

Case Reports

Concomitant Human Herpes Virus 6 and nivolumab-related pneumonitis: Potential pathogenetic insights

Periklis G Foukas et al. IDCases. 2018.

. 2018 Feb 8:11:101-103.

doi: 10.1016/j.idcr.2018.01.013. eCollection 2018.

Authors

Periklis G Foukas¹, Sotirios Tsiodras², Panagiota Economopoulou³, Aris Spathis⁴, Maria Mademli⁵, Konstantinos Leventakos¹, Amanda Psyrri³, Petros Karakitsos⁴, Ioannis G Panayiotides¹

Affiliations

¹ 2nd Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
² 4th Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
³ Medical Oncology Unit, 2nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
⁴ Department of Cytopathology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
⁵ 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.

PMID: 29552493
PMCID: PMC5852387
DOI: 10.1016/j.idcr.2018.01.013

Abstract

The development of immune system modulating agents, such as immune checkpoint inhibitors (ICIs), has revolutionized cancer treatment. Nivolumab, a human monoclonal antibody against PD-1, has emerged as an efficient treatment for various malignancies, including non-small cell lung cancer (NSCLC); however, it is associated with important immune related side-effects, attributed to organ-specific inflammation, such as immune-mediated pneumonitis, a relatively uncommon, albeit potentially fatal adverse event. We herein present the unique case of severe interstitial pneumonitis with concomitant detection of Human Herpes Virus 6 (HHV-6) in a nivolumab treated patient with NSCLC. Potential pathogenetic mechanisms are discussed.

Keywords: Human Herpesvirus 6; Immunotherapy; Lung cancer; Nivolumab.

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Figures

**Fig. 1**
Nivolumab treatment timeline.

**Fig. 2**
Pulmonary fibrosis with focal lymphoplasmacytic chronic inflammation, suggestive of nivolumab-related pneumonitis.

See this image and copyright information in PMC

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References

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1. Leventakos K., Mansfield A.S. Advances in the treatment of non-small cell lung cancer: focus on nivolumab, pembrolizumab, and atezolizumab. BioDrugs. 2016;30:397–405. - PubMed
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1. Isaacson E., Glaser C.A., Forghani B., Amad Z., Wallace M., Armstrong R.W. Evidence of human herpesvirus 6 infection in 4 immunocompetent patients with encephalitis. Clin Infect Dis. 2005;40:890–893. - PubMed
1. Cone R.W. Human herpesvirus 6 as a possible cause of pneumonia. Semin Respir Infect. 1995;10:254–258. - PubMed

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[1] Martin-Liberal J., Ochoa de Olza M., Hierro C., Gros A., Rodon J., Tabernero J. The expanding role of immunotherapy. Cancer Treat Rev. 2017;54:74–86. - PubMed

[2] Martin-Liberal J., Ochoa de Olza M., Hierro C., Gros A., Rodon J., Tabernero J. The expanding role of immunotherapy. Cancer Treat Rev. 2017;54:74–86. - PubMed

[3] Leventakos K., Mansfield A.S. Advances in the treatment of non-small cell lung cancer: focus on nivolumab, pembrolizumab, and atezolizumab. BioDrugs. 2016;30:397–405. - PubMed

[4] Leventakos K., Mansfield A.S. Advances in the treatment of non-small cell lung cancer: focus on nivolumab, pembrolizumab, and atezolizumab. BioDrugs. 2016;30:397–405. - PubMed

[5] Tabchi S., Messier C., Blais N. Immune-mediated respiratory adverse events of checkpoint inhibitors. Curr Opin Oncol. 2016;28:269–277. - PubMed

[6] Tabchi S., Messier C., Blais N. Immune-mediated respiratory adverse events of checkpoint inhibitors. Curr Opin Oncol. 2016;28:269–277. - PubMed

[7] Isaacson E., Glaser C.A., Forghani B., Amad Z., Wallace M., Armstrong R.W. Evidence of human herpesvirus 6 infection in 4 immunocompetent patients with encephalitis. Clin Infect Dis. 2005;40:890–893. - PubMed

[8] Isaacson E., Glaser C.A., Forghani B., Amad Z., Wallace M., Armstrong R.W. Evidence of human herpesvirus 6 infection in 4 immunocompetent patients with encephalitis. Clin Infect Dis. 2005;40:890–893. - PubMed

[9] Cone R.W. Human herpesvirus 6 as a possible cause of pneumonia. Semin Respir Infect. 1995;10:254–258. - PubMed

[10] Cone R.W. Human herpesvirus 6 as a possible cause of pneumonia. Semin Respir Infect. 1995;10:254–258. - PubMed

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Concomitant Human Herpes Virus 6 and nivolumab-related pneumonitis: Potential pathogenetic insights

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Concomitant Human Herpes Virus 6 and nivolumab-related pneumonitis: Potential pathogenetic insights

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