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Checkpoint inhibitor pneumonitis — SCE Respiratory MCQ

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HardLung CancerCheckpoint inhibitor pneumonitisSCE Respiratory

A 71-year-old man with metastatic squamous NSCLC on immunotherapy develops new cough, dyspnoea and bilateral ground-glass opacities after four cycles. CRP is 12 mg/L, viral PCR is negative and there is no heart failure. What is the most likely diagnosis?

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Correct answer: B — Immune checkpoint inhibitor pneumonitis

New dyspnoea and bilateral ground-glass opacities during immune checkpoint inhibitor therapy suggest immunotherapy-related pneumonitis after infection and heart failure are considered. Emphysema progression would not usually cause acute ground-glass infiltrates. TB pleuritis and PE have different imaging and clinical patterns, and PE is not confirmed by ground-glass change.

Reference: NICE NG122; ESMO immunotherapy toxicity guidance