A Case of Pulmonary Fibrosis and COVID-19-Related Pneumonia in a Pembrolizumab-Treated Patient

Abstract

Pembrolizumab is used as a first-line treatment of non-small cell lung cancer. Pneumonitis and interstitial lung disease are among the most common immune-related adverse events. The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on patients with cancer treated with chemotherapy or immune checkpoint inhibitors (ICIs) is not fully known. Blocking immune checkpoints may conversely augment dysfunctional T-cell responses in severe patients and, in turn, mediate immunopathology. Here, we present a case of SARS-CoV-2 infection complicated by acute respiratory distress syndrome (ARDS) and a fibrotic-like pattern in a patient treated with pembrolizumab for lung cancer. The patient showed a dramatic clinical and radiological response after steroid therapy. Further research is needed to better understand the long-term implications of pembrolizumab therapy in patients recovering from coronavirus disease 2019 (COVID-19) and to develop evidence-based guidelines for managing these complex cases. Patients undergoing oncologic immunotherapy might benefit from early high-dose steroid treatment in cases of viral infections, such as SARS-CoV-2.

Keywords: fibrotic-like pattern; pembrolizumab; severe acute respiratory syndrome coronavirus 2.

Figure 1

Timeline shows the chronology of imaging scans, COVID-19 swab results, and therapies from the diagnosis of cancer and COVID-19.

Figure 2

Lung CT scan. (A) July 2023. Tumor mass, 24 × 16 mm, at left superior lobe without signs of interstitial involvement (orange arrowhead). (B) 17 November 2023. Tumor mass, 15 mm, at left superior lobe with signs of interstitial involvement with “ground glass” and “crazy paving” areas (blue arrowheads), in particular in lower lobes. (C) February 2024. Crazy paving interstitiopathy areas were reduced and the of inferior lobes consolidations, located where traction bronchiectasis had arisen, disappeared.