Immunotherapy-induced pneumonitis - metastatic melanoma

Case contributed by Dr Bruno Di Muzio

Presentation

Previous history of metastatic melanoma. No fevers or raised septic markers.

Patient Data

Age: 40 years
Gender: Female

Extensive areas of consolidation and groundglass opacities with a relatively symmetrical distribution involving mostly the upper lobes. No pleural effusion. The airways are unremarkable. 

There are two tiny subcutaneous nodules in the medial aspect of the right breast. Extensive bone metastatic disease. 

This patient was not clinically septic and the pattern of consolidation/groundglass is relatively symmetrical. On review of her medical history, she has started immunotherapy 2 months ago for her advanced metastatic melanoma. 

Her previous chest imaging was normal (following study - chest radiograph). 

X-ray

Chest radiograph (3 months prior)

The lungs and pleural spaces are clear, the mediastinal contours are within the normal limits. 

X-ray

Chest radiograph (1 month after)

Immunotherapy has been withheld and, some weeks later, the lungs have improved and there are some residual perihilar upper lobes infiltrates.  

CT

CT Chest (4 months after)

A few months later, the lungs have mostly cleared, but a small right pleural effusion has developed and now multiple liver metastases are seen. 

Case Discussion

This case illustrates the impressive appearances that immunotherapy-induced pneumonitis can have on imaging.

The patient was receiving anti-PD1 (nivolumab) to treat her advanced metastatic melanoma. 

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Case information

rID: 62277
Published: 8th Dec 2018
Last edited: 27th Mar 2019
System: Chest
Inclusion in quiz mode: Included

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