Lessons from the diagnosis and treatment of severe immune checkpoint inhibitor-associated pneumonia: a case report

Herein, we report a case of an elderly male patient who underwent extended radical resection of cardiac carcinoma after regular chemotherapy combined with sintilimab (PD-1 monoclonal antibody) immunotherapy complicated with severe pneumonitis postoperatively. We performed several treatments for aspiration pneumonitis; however, the patient's pulmonary infection and oxygenation were not efficiently improved. The multidisciplinary team considered it an immune checkpoint inhibitor-associated pneumonitis after diagnosis and treatment and then modified the treatment regimen. The pulmonary inflammation was effectively controlled with improved oxygenation; the patient was gradually weaned from the ventilator and finally discharged. The possibility of immune checkpoint inhibitor-associated pneumonitis should be fully considered particularly for patients with a history of immunosuppressive therapy with clinical symptoms of severe pneumonitis. Pneumonia is well known. Immune pneumonia may be a new problem. It occurs in 2–5% of patients with immune therapy. It is a bad reaction with low incidence. If this disease is not treated in time, it will cause a relatively terrible result. The fatality rate can reach 12.8–22.7%. The most severe cases can be life threatening. At present, the reason for immune pneumonia is not clear. Some experts believe that it is related to immune change. Dyspnea, cough, fever and chest pain are symptoms of this disease. Although the incidence of immune pneumonia is very low, it should be noted. If you are on immunotherapy, consult your doctor when you feel unwell.