Case report: Checkpoint inhibitor pneumonitis with positive anti-melanoma differentiation-associated gene 5 antibodies in a patient with lung cancer

Front Immunol. 2024 Jan 12:14:1309531. doi: 10.3389/fimmu.2023.1309531. eCollection 2023.

Abstract

With the widespread use of immune checkpoint inhibitors to treat various cancers, pulmonary toxicity has become a topic of increasing concern. Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies are strongly associated with rapidly progressive interstitial lung disease (RP-ILD) in patients with clinically amyopathic dermatomyositis. However, anti-MDA5 antibody expression has not been reported in patients with immune-related adverse events. We present the case of a 74-year-old man with lung adenocarcinoma who developed RP-ILD after treatment with immune checkpoint inhibitors. Further investigation revealed multiple autoantibodies, including anti-MDA5 antibodies. He initially responded to systemic glucocorticoids, immunosuppressants, and tocilizumab but eventually died from worsening pneumomediastinum. This case is the first one to suggest that checkpoint inhibitor pneumonitis can present as RP-ILD with positive anti-MDA5 antibodies, which may be predictive of a poor prognosis.

Keywords: anti-MDA5 antibodies; immune checkpoint inhibitors; immune-related adverse events; pneumonitis; rapidly progressive interstitial lung disease.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Comment

MeSH terms

  • Aged
  • Autoantibodies
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Lung Diseases, Interstitial* / diagnosis
  • Lung Diseases, Interstitial* / drug therapy
  • Lung Diseases, Interstitial* / etiology
  • Lung Neoplasms* / complications
  • Lung Neoplasms* / drug therapy
  • Male
  • Pneumonia* / diagnosis
  • Pneumonia* / drug therapy
  • Pneumonia* / etiology

Substances

  • Autoantibodies
  • Immune Checkpoint Inhibitors

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National High Level Hospital Clinical Research Funding (grant numbers 2022-PUMCH-A-129, 2022-PUMCH-C-054). These funding sources had no role in the study design or execution, analyses, interpretation of the data, or decision to submit results.