Background

Immune checkpoint inhibitors (ICIs) are a promising new treatment for different types of cancer. The infectious complications in patients taking ICIs are rare.

Case report

A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy.

Conclusions

Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.

中文翻译：

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免疫检查点抑制剂治疗后曲霉菌和沙门氏菌引起的坏死性肺炎：一个不寻常的病例和文献综述

背景

免疫检查点抑制剂（ICIs）是治疗不同类型癌症的一种有前景的新疗法。服用 ICI 的患者出现感染并发症的情况很少见。

案例报告

一名 58 岁男性，一个月前接受了帕博利珠单抗（PD-1 抑制剂）治疗食管鳞状细胞癌的化疗，在纤维支气管镜检查后不久因呼吸急促入院急诊室。下呼吸道。胸部计算机断层扫描显示右上叶进行性实变。D 组沙门氏菌是从支气管肺泡灌洗液 (BAL) 液体培养物中分离出来的。同一临床样本的真菌培养产生黑曲霉；此外，在患者的支气管肺泡灌洗液和血清中均发现了高滴度（高于临界值）的曲霉抗原。尽管采用了有效谱和适当剂量的抗菌治疗，患者仍因弥散性血管内凝血病死亡。

结论

ICI 治疗后了解肺炎病因中的异常病原体可能有助于避免漏诊。