{
  "abstract": "Immune checkpoint inhibitor (ICI) have substantially extended survival in patients with extensive-stage small-cell lung cancer (ES-SCLC), yet they also carry the risk of life-threatening immune-related adverse events (irAEs). Clinical experience in managing multi-organ irAEs (MO-irAEs) complicated by respiratory failure and subsequent severe pneumonia remains exceedingly scarce. Here we report a 71-year-old patient with ES-SCLC (stage IVb, with brain and splenic metastases) who, after four cycles of serplulimab plus chemotherapy, sequentially developed myocarditis, myositis, and hepatic injury. Following premature tapering of glucocorticoid therapy, the patient experienced a recurrence of ICI-related toxicity, manifesting as hypophysitis, primary hypothyroidism, and adrenal insufficiency-alongside respiratory failure-and later acquired multidrug-resistant infection during the treatment course. Through individualized moderate-dose glucocorticoids, comprehensive hormone replacement, and pathogen-directed antimicrobial therapy with eravacycline and ceftazidime-avibactam guided by metagenomic next-generation sequencing (mNGS), the infection was ultimately brought under control and multi-organ dysfunction reversed. This case underscores several key points: (1) serplulimab can precipitate multi-endocrine gland insufficiency, and severe hypothyroidism may be one of the factors contributing to the respiratory failure, mandating a high index of clinical suspicion; (2) glucocorticoid regimens should adhere to adequate initial dosing, sufficient duration, and slow tapering-abrupt discontinuation risks triggering recurrence of ICI-related toxicity; and (3) rapid, precise lower-respiratory-tract pathogen identification coupled with targeted antimicrobial therapy offers particular value in managing severe pneumonia caused by drug-resistant organisms.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Clinical Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center",
    "Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine",
    "Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine",
    "Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tingrui Zhao"
    },
    {
      "affs": [
        1
      ],
      "name": "Rongzhang Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "Yuhua Ma"
    },
    {
      "affs": [
        2
      ],
      "name": "Gen Li"
    },
    {
      "affs": [
        3
      ],
      "name": "Xia Gu"
    },
    {
      "affs": [
        1
      ],
      "name": "Yukai Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "He Sun"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/62z0g9at27eb6.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.2003924",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731381/",
  "id": "62z0g9at27eb6",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.2003924/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2730|Cancer Immunotherapy and Biomarkers"
    ]
  ],
  "openalex": "W7223154985",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.2003924/pdf",
  "pmcid": "PMC13731381",
  "pmid": "42984913",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/62z0g9at27eb6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:17Z",
      "native_id": "10.3389/fimmu.2026.2003924",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.2003924/full"
    },
    {
      "first_seen": "2026-11-08T12:21:35Z",
      "native_id": "PMC13731381",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fimmu.2026.2003924"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Cancer Immunotherapy and Biomarkers",
      "subfield": "oncology"
    }
  ],
  "title": "Immune checkpoint inhibitor-induced multi-organ immune damage complicated by severe pneumonia: case report",
  "title_text": "Immune checkpoint inhibitor-induced multi-organ immune damage complicated by severe pneumonia: case report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:35Z",
  "url": "https://research.draconitic.com/paper/62z0g9at27eb6",
  "venue": "Frontiers in Immunology",
  "versions": []
}