Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2024; 16(9): 482-488
Published online Sep 28, 2024. doi: 10.4329/wjr.v16.i9.482
Pneumocystis pneumonia in stage IIIA lung adenocarcinoma with immune-related acute kidney injury and thoracic radiotherapy: A case report
Ya-Wen Zheng, Jia-Chao Pan, Jin-Feng Wang, Jian Zhang
Ya-Wen Zheng, Jian Zhang, Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Jia-Chao Pan, Department of Gastroenterology, Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Jin-Feng Wang, Department of Pulmonary and Critical Care Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Co-corresponding authors: Ya-Wen Zheng and Jian Zhang.
Author contributions: Zheng YW and Zhang J conceived the manuscript; Zheng YW, Wang JF and Zhang J treated the patient; Zheng YW and Pan JC collected the patient information and acquired the data; Zheng YW and Pan JC analyzed the data and wrote the manuscript; Zheng YW and Zhang J jointly formulated the patient's treatment plan, with equal contributions to the manuscript as co-corresponding authors; Zheng YW takes primary responsibility for communication with the journal during the manuscript submission, peer review and publication processes; all authors reviewed the manuscript critically and approved the content.
Supported by Shandong Natural Science Foundation, No. ZR2021QH034; and China Postdoctoral Science Foundation, No. 2023M731305.
Informed consent statement: The authors certify that they have obtained all appropriate patient consent forms prior to study enrollment.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Wen Zheng, MD, PhD, Associate Chief Physician, Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Jinan 250000, Shandong Province, China. zyawen06@126.com
Received: July 11, 2024
Revised: August 16, 2024
Accepted: September 3, 2024
Published online: September 28, 2024
Processing time: 77 Days and 16.7 Hours
Abstract
BACKGROUND

Immune checkpoint inhibitors (ICIs) are therapeutic agents for advanced and metastatic non-small cell lung cancer (NSCLC) with high clinical antitumor efficacy. However, immune-related adverse events occur in 20% of these patients and often requiring treatment with immunosuppressive agents, such as corticosteroids. Consequently, this may increase the risk of patients to opportunistic infections. Pneumocystis jirovecii pneumonia (PJP), a rare but serious opportunistic infection typically observed in patients with human immunodeficiency virus, can also occur in cancer patients undergoing long-term glucocorticoid treatment.

CASE SUMMARY

We report a case of a 56-year-old male with squamous NSCLC treated with triplimab combined with paclitaxel, carboplatin, and radical thoracic radiation therapy. Following this regimen, he developed acute kidney injury (AKI) with elevated creatinine levels. After concurrent radical chemoradiotherapy ended, he developed a grade 3 immune-related AKI. High-dose corticosteroids were administered to treat AKI, and renal function gradually recovered. Corticosteroids were reduced to a dose of 10 mg prednisone equivalent daily eight weeks later; however, he developed severe pneumonia with spontaneous pneumothorax. Next-generation sequencing of the bronchoscopic lavage revealed PJP co-infection with herpes simplex virus 1 and cytomegalovirus. The inflammation was more severe in areas exposed to radiation. Piperacillin-tazobactam, acyclovir, sulfamethoxazole, and trimethoprim were used to control the infection. The patient recovered, and immunotherapy was terminated.

CONCLUSION

PJP is rare but can occur in patients with ICI adverse events and should be differentiated from tumor progression or immune-related adverse events. Thoracic radiation may increase risk, necessitating careful monitoring and prevention.

Keywords: Pneumocystis pneumonia; Immunerelated adverse events; Immunotherapy; Thoracic radiotherapy; Acute kidney injury; Case report

Core Tip: A patient with squamous lung cancer was treated with triplimab combined with paclitaxel, carboplatin, and radical thoracic radiation therapy. Despite the good therapeutic effect, he developed a grade 3 immune-related acute kidney injury, prompting high-dose corticosteroids treatment. Eight weeks later, the patient developed severe pneumonia with spontaneous pneumothorax, and was diagnosed with Pneumocystis jirovecii pneumonia (PJP) co-infection with the herpes simplex virus 1 and cytomegalovirus. PJP is rare but might occur in patients with immune checkpoint inhibitor adverse events, highlighting the need to be differentiated from tumor progression or immune-related adverse events.