CASE REPORT article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1672093
This article is part of the Research TopicThe Role of Immunotherapy in Cancer Therapy and Its ChallengesView all 5 articles
Fatal Early-Onset Checkpoint Inhibitor Pneumonitis in a Patient with Advanced Squamous-Cell Lung Cancer with Underlying Pulmonary Fibrosis: A Case Report and Review of the Literature
Provisionally accepted
- Poznan University of Medical Sciences, Poznań, Poland
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Introduction We report a case of fulminant checkpoint inhibitor pneumonitis (CIP) occurring after a single dose of immune checkpoint inhibitor (ICI) therapy in a patient with advanced non-small cell lung cancer and underlying fibrotic interstitial lung disease (ILD), illustrating a rare but clinically significant and often fatal immune-related adverse event. Main symptoms and clinical findings A 78-year-old woman with stage IVb squamous-cell carcinoma of the lung and idiopathic pulmonary fibrosis (IPF) developed progressive dyspnea, hypoxemia, and systemic inflammation shortly after receiving her first dose of pembrolizumab. High-resolution computed tomography (HRCT) revealed new bilateral ground-glass opacities superimposed on a fibrotic background with a definite usual interstitial pneumonia (UIP) pattern. Diagnoses, interventions, and outcomes Fulminant early-onset CIP was diagnosed after exclusion of infectious causes. Despite discontinuation of immunotherapy and escalation of immunosuppressive treatment— including high-dose corticosteroids, mycophenolate mofetil, and infliximab—the patient's respiratory status deteriorated, resulting in death 27 days after treatment initiation. Conclusion This case illustrates that life-threatening CIP can occur after a single dose of ICI in patients with fibrotic ILD. It emphasizes the urgent need for risk-adapted treatment strategies and enhanced monitoring protocols in this high-risk population.
Keywords: Checkpoint inhibitor pneumonitis, Idiopathic Pulmonary Fibrosis, Pembrolizumab, lung cancer, Immune-related adverse event
Received: 23 Jul 2025; Accepted: 06 Oct 2025.
Copyright: © 2025 Keller, Żarczyński, Rybacka and Kuźnar-Kamińska. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Daria Keller, daria.keller@ump.edu.pl
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