Interstitial lung disease (ILD) has rarely been reported as a manifestation of giant cell arteritis (GCA). We herein report a unique case of GCA in a 76-year-old woman who presented with ILD as an initial manifestation of GCA. Ten years before admission, she had been diagnosed with granulomatous ILD of unknown etiology. Corticosteroid therapy induced remission. One year after the cessation of corticosteroid therapy, she was admitted with a persistent fever. After admission, she developed left oculomotor paralysis. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) proved extremely useful in establishing the diagnosis. Our case promotes awareness of GCA as a possible diagnosis for granulomatous ILD with unknown etiology.
Immune checkpoint inhibitors (ICIs) have been used to treat lung cancer. Several types of ICI-related interstitial lung diseases have been reported, including organizing pneumonia, non-specific interstitial pneumonia, and diffuse alveolar damage. However, pembrolizumab-associated bronchiolitis requiring treatment for persistent cough has not yet been reported. Here, we describe a patient who developed dry cough while being treated with pembrolizumab for lung adenocarcinoma. Radiography and lung biopsy findings indicated bronchiolitis. His cough improved after the discontinuation of pembrolizumab and treatment with erythromycin, an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β
2
agonist.
━━ Background. In anaplastic lymphoma kinase (ALK)-rearranged lung cancer, ALK tyrosine kinase inhibitors have been reported to significantly prolong the progression free survival versus platinum-based combination therapy. In contrast, the effect of immune checkpoint inhibitors has been reported to be limited. We herein report a case of initial resistance to alectinib with a durable response to atezolizumab plus bevacizumab/carboplatin/paclitaxel combination therapy. Case. A 74-year-old woman with cough was referred to our hospital. She was diagnosed with ALK-rearranged lung adenocarcinoma cT4N3M1a stage IVA (PLE) and treated with alectinib. About two months later, the cancerous pleuritis and pericarditis worsened, and alectinib was continued after thoracic and pericardial drainage. Because cancerous pleuritis and pericarditis worsened even further, she was treated with atezolizumab plus bevacizumab/carboplatin/paclitaxel combination therapy. She subsequently obtained a long-term survival. Conclusion. In cases resistant to first-line ALK tyrosine kinase inhibitors, other ALK tyrosine kinase inhibitors are often considered, but combined immunotherapy may be effective in cases of initial resistance.
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