摘要
1例56岁男性鼻咽癌患者因行放疗、化疗、靶向治疗后疾病进展, 接受化疗联合免疫治疗(卡培他滨+信迪利单抗)。第3次接受免疫治疗前, 患者相关检查均未见异常;治疗第3天, 患者出现咳嗽、气促等症状, 胸部CT提示两肺炎性病变。痰培养、痰涂片、G试验、GM试验及自身抗体检查结果均为阴性, 排除感染性肺炎和自身免疫性肺炎。卡培他滨呼吸系统常见不良反应为咽部不适, 未见引起大面积肺炎的报道, 因此考虑患者为信迪利单抗引起免疫相关性肺炎的可能性大。予甲泼尼龙静脉注射及头孢哌酮钠舒巴坦钠、莫西沙星静脉滴注等治疗, 病情稳定后甲泼尼龙逐渐减量, 之后换为泼尼松口服治疗。服用泼尼松第10天, 患者气促加重, 胸部CT复查结果提示两肺炎性病变较前加重。再次给予甲泼尼龙静脉注射, 病情未能好转。
A 56-year-old male patient with nasopharyngeal carcinoma had progressed disease after receiving radiotherapy,chemotherapy,and targeted therapy,etc.Then he received chemotherapy combined with immunotherapy(capecitabine and sintilimab).Before receiving the 3rd immunotherapy,no abnormality was found in the relevant examination in the patient.On the 3rd day of treatment,he developed cough,shortness of breath,and other symptoms,and chest CT imaging indicated inflammatory lesion of both lungs.The results of sputum culture,sputum smear examination,G test,GM test,and autoantibody examination were all negative.Infectious pneumonia and interstitial pneumonia with autoimmune features were excluded.The common respiratory adverse reaction to capecitabine was pharyngeal discomfort,and no large-scale pneumonia caused by capecitabine was reported.Therefore,it was considered to be immune-associated pneumonitis cause by sintilimab.Treatments such as intravenous injection of methylprednisolone,IV infusion of cefoperazone sodium and sulbactam sodium and moxifloxacin were given and the patient′s condition was improved.After that,methylprednisolone dose was gradually reduced,and then changed to oral prednisone.On the 10th day of oral prednisone,the symptom of shortness of breath worsened.Chest CT imaging indicated that the pneumonitis was more severe than before.Intravenous methylprednisolone was re-given but the condition was not improved.
作者
王芬芳
鲍静亚
邬琪焕
Wang Fenfang;Bao Jingya;Wu Qihuan(Department of Medical Oncology,Xiangshan First People′s Hospital Medical and Health Group,Zhejiang Province,Ningbo 315700,China)
出处
《药物不良反应杂志》
CSCD
2023年第3期190-192,共3页
Adverse Drug Reactions Journal
关键词
免疫检查点抑制剂
肺炎
间质性
信迪利单抗
免疫相关性肺炎
Immune checkpoint inhibitors
Lung diseases,interstitial
Sintilimab
Immune-associated pneumonitis
作者简介
通信作者:邬琪焕,Email:297252359@qq.com。
