Influenza A (H1N1) virus infection complicated by checkpoint inhibitor pneumonitis: A case report.
Yifan Cheng, Huiying Zhao, Youzhong An
✦ AI-curated · Sources linked
Case in brief
After neoadjuvant immunotherapy, a patient developed respiratory dysfunction and progressive pulmonary lesions. Imaging and positive influenza A (H1N1) testing, interpreted alongside the immunotherapy history and symptoms, supported concurrent checkpoint inhibitor pneumonitis (CIP) and H1N1 pneumonia. Antiviral and empirical antibiotic treatment did not halt deterioration; radiographic worsening and respiratory failure persisted. Following comprehensive evaluation, glucocorticoids were restarted to treat CIP. Symptoms and pulmonary lesions then improved, and the patient had a favorable recovery.
What made this case unusual
The management dilemma was concurrent active H1N1 pneumonia and CIP: glucocorticoids are standard first-line treatment for CIP but are traditionally avoided in confirmed viral pneumonia.
Diagnostic / clinical pearl
In a patient receiving checkpoint inhibitor therapy, progressive lung disease with confirmed influenza may reflect concurrent CIP as well as viral pneumonia; lack of response to anti-infective treatment should prompt reassessment for overlapping causes.
Why it matters
This case illustrates that, after comprehensive evaluation, glucocorticoids may be used for CIP despite active influenza infection, with improvement reported in this patient.