Immune Checkpoint Inhibitor-Associated Hydropneumothorax: A Rare Case Report with Histopathologic Insights

Le résumé fourni par la source

Immune checkpoint inhibitors (ICI) targeting programmed death-ligand 1 have transformed the management of advanced malignancies, yet are associated with a spectrum of immune-related pulmonary toxicities, most notably checkpoint inhibitor pneumonitis (CIP). While CIP is a well-documented immune-related adverse event, the occurrence of hydropneumothorax as a manifestation of programmed death-ligand 1 inhibitor-induced pulmonary immune-related adverse event is exceedingly rare, with very limited prior reports. The authors present a case of hydropneumothorax in a 75-year-old Hispanic male with hepatocellular carcinoma who developed respiratory symptoms 3 weeks after initiating atezolizumab and bevacizumab, following extensive prior exposure to ICIs. Hydropneumothorax occurred after initiation of atezolizumab and bevacizumab, and CIP was favoured clinically after alternative causes, including bevacizumab, prior thoracic radiation, and talc pleurodesis were evaluated. This case contributes to the growing literature by presenting one of the earliest reports of ICI-associated hydropneumothorax with histopathological characterisation, while also highlighting potential contributing factors to this complication. Clinicians should be aware of hydropneumothorax as a potential manifestation of CIP as it may require acute surgical intervention and inform future diagnostic and therapeutic strategies.

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