Immune checkpoint inhibitor-induced multi-organ immune damage complicated by severe pneumonia: case report
4 affiliations
- 1Department of Clinical Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center
- 2Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine
- 3Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine
- 4Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine
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.
Related
- Efficacy and Safety of Immune Checkpoint Inhibitors for Lung Cancer Complicated by Interstitial Pneumonia: The CS-Lung 003 Study, Branch Number 28.
- Advanced Therapies for the Management of Immune Checkpoint Inhibitor-Induced Colitis
- Case Report: Immune checkpoint inhibitor–induced hypophysitis presenting as acute paralytic ileus mimicking mechanical bowel obstruction in a patient affected by advanced non-small cell lung cancer
- Immune Checkpoint Inhibitor‐Induced Diabetic Ketoacidosis in a Patient With Pre‐Existing Type 2 Diabetes: A Case Report
- Integrated multi-omics identifies distinct immune signatures with diagnostic and therapeutic implications in immune checkpoint inhibitor-induced myocarditis
BibTeX
@article{zhao2026immune,
title = {{Immune checkpoint inhibitor-induced multi-organ immune damage complicated by severe pneumonia: case report}},
author = {Tingrui Zhao and Rongzhang Chen and Yuhua Ma and Gen Li and Xia Gu and Yukai Chen and He Sun},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.2003924},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.2003924/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Immune checkpoint inhibitor-induced multi-organ immune damage complicated by severe pneumonia: case report
AU - Tingrui Zhao
AU - Rongzhang Chen
AU - Yuhua Ma
AU - Gen Li
AU - Xia Gu
AU - Yukai Chen
AU - He Sun
PY - 2026
DA - 2026/10/21
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.2003924
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.2003924/full
AB - 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.
SN - 1664-3224
ER -