Rapidly fatal pneumonitis from immunotherapy and concurrent SARS-CoV-2 infection in a patient with newly diagnosed lung cancer

  1. Christine M. Lovly
  2. Kelli L. Boyd
  3. Paula I. Gonzalez-Ericsson
  4. Cindy L. Lowe
  5. Hunter M. Brown
  6. Robert D. Hoffman
  7. Brent C. Sterling
  8. Meghan E. Kapp
  9. Douglas B. Johnson
  10. Prasad R. Kopparapu
  11. Wade T. Iams
  12. Melissa A. Warren
  13. Michael J. Noto
  14. Brian I. Rini
  15. Madan Jagasia
  16. Suman R. Das
  17. Justin M. Balko

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Abstract

Immune checkpoint inhibitors (ICIs) are used for the treatment of numerous cancers, but risks associated with ICI-therapy during the COVID-19 pandemic are poorly understood. We report a case of acute lung injury in a lung cancer patient initially treated for ICI-pneumonitis and later found to have concurrent SARS-CoV-2 infection. Post-mortem analyses revealed diffuse alveolar damage in both the acute and organizing phases, with a predominantly CD68+ inflammatory infiltrate. Serum was positive for anti-SARS-CoV-2 IgG, suggesting that viral infection predated administration of ICI-therapy and may have contributed to a more fulminant clinical presentation. These data suggest the need for routine SARS-CoV-2 testing in cancer patients, where clinical and radiographic evaluations may be non-specific.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.29.20085738: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Plasma samples were tested for IgM and IgG antibody content at 1:1 and 1:100 dilutions using the Genscript SARS-CoV-2 Spike S1-Receptor Binding Domain IgM & IgG ELISA Detection Kit according to the manufacturers protocol (cat.#
    IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    Automated quantification was performed on whole slide images using QuPath software1.
    QuPath
    suggested: (QuPath, RRID:SCR_018257)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.29.20085738v1 on medRxiv