Releasing the brakes: a case report of pulmonary arterial hypertension induced by immune checkpoint inhibitor therapy

Abstract

Immune checkpoint inhibitors successfully treat various malignancies by inducing an immune response to tumor cells. However, their use has been associated with a variety of autoimmune disorders, such as diabetes, hepatitis, and pneumonitis. Pulmonary arterial hypertension due to checkpoint inhibitor use has not yet been described. We present a novel case of pulmonary arterial hypertension associated with systemic lupus erythematosus and Sjogren's syndrome overlap that was induced by therapy with the checkpoint inhibitor durvalumab.

Keywords: autoimmune disease; durvalumab; immunotherapy; programmed death-ligand 1 inhibitor; right heart failure.

Fig. 1.

Timeline, imaging studies and hemodynamic values. (a) A timeline of the patient’s clinical course. SCLC: small cell lung cancer, DM1: type 1 diabetes mellitus, RHC: right heart catheterization, PH: pulmonary hypertension. (b) A computer tomography image depicting mild diffuse ground-glass opacities as well as pulmonary artery enlargement and bilateral pleural effusions. (c) A two-dimensional-echocardiographic apical four chamber view. Note right atrial and right ventricular enlargement, leftward shift of interventricular septum (*) and interatrial septum (**), compression of left atrium and left ventricle, as well as presence of a pericardial effusion (#). (d) Hemodynamic values during right heart catheterization. RA: right atrium; RV: right ventricle; PA: pulmonary artery; PAWP: PA wedge pressure; LVEDP: left ventricular end-diastolic pressure; CO: cardiac output; CI: cardiac index; PVR: pulmonary vascular resistance; WU: Wood units; s: systole; d: diastole; m: mean. Dobutamine was stopped during RHC measurements.