Suo H, Shi YJ, Huang ZD, Xu K, Huang H. Pulmonary reversed halo cycles and consolidations after immunotherapy: A case report. World J Clin Cases 2023; 11(28): 6938-6942 [PMID: 37901007 DOI: 10.12998/wjcc.v11.i28.6938]
Corresponding Author of This Article
Hui Huang, MD, Chief Physician, Professor, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Street, Dongcheng District, Beijing 100730, China. pumchhh@126.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 6, 2023; 11(28): 6938-6942 Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6938
Pulmonary reversed halo cycles and consolidations after immunotherapy: A case report
Hong Suo, Yu-Jie Shi, Zhao-Di Huang, Kai Xu, Hui Huang
Hong Suo, Department of Pulmonary and Critical Care Medicine, The Affiliate Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China
Yu-Jie Shi, Hui Huang, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
Zhao-Di Huang, Department of Internal Medicine, Inner Mongolia Medical University, Hohhot 010011, Inner Mongolia Autonomous Region, China
Kai Xu, Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Suo H and Shi YJ contributed equally to this work; Huang H is the guarantor of the content of the manuscript including the data and analysis; Huang H and Suo H conceived and designed the study; Suo H, Shi YJ, Huang ZD and Xu K performed the study and also analyzed the data; Huang H and Shi YJ wrote the paper; all the authors have read and approved the final version of the manuscript.
Supported byNational High Level Hospital Clinical Research Funding, No. 2022-PUMCH-C-069 and No. 2022-PUMCH-A-009.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
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: Hui Huang, MD, Chief Physician, Professor, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Street, Dongcheng District, Beijing 100730, China. pumchhh@126.com
Received: July 18, 2023 Peer-review started: July 18, 2023 First decision: August 15, 2023 Revised: August 21, 2023 Accepted: September 11, 2023 Article in press: September 11, 2023 Published online: October 6, 2023 Processing time: 68 Days and 21.3 Hours
Abstract
BACKGROUND
Immune checkpoint inhibitor-associated interstitial lung disease (ICI-ILD) and opportunistic pneumonias are the main pulmonary complications during immunotherapy for malignancies. The organizing pneumonia (OP) pattern is one of the common radiological manifestations of ICI-ILD, and OP is the most common cause of reversed halo cycles and consolidations. However, opportunistic pneumonias should be excluded.
CASE SUMMARY
In this report, we described a case of a 44-year-old man with esophageal cancer who showed multiple reversed-halo cycles and consolidations on chest computed tomography (CT) after he had a cold during immunotherapy. He was diagnosed with esophageal squamous-cell cancer (T2NIM0) after surgery. Then, he was successfully treated with 6 cycles of chemotherapy plus tislelizumab, one cycle of radiotherapy and 9 cycles of tislelizumab. Two months later, he complained of low-grade fever and cough with nonpurulent sputum after he had a cold. Community-acquired pneumonia was considered, but moxifloxacin was ineffective. Chest CT showed multiple reversed-halo cycles and consolidations. Mycobacterium tuberculosis was identified with next-generation sequence analysis of bronchoalveolar lavage fluid (BALF). Two months later, he improved with standard anti-tuberculosis medications. Both the cycles and consolidations disappeared in the repeat CT after 6 mo of medications.
CONCLUSION
When chest CT shows reversed-halo cycles and consolidations in patients during anticancer immunotherapy, both ICI-ILD and infectious pneumonia should be considered. BALF microbiological analysis was helpful to differentiate them.
Core Tip: Immune checkpoint inhibitor-associated interstitial lung disease and variable opportunistic pneumonias are the main pulmonary complications of malignancies during immune treatment. Although organizing pneumonia is the most common cause of reversed-halo cycles and consolidations, opportunistic pneumonias should be excluded first. Bronchoalveolar lavage fluid microbiological analysis was a helpful diagnostic tool.
