Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab

Ryo Sawada; Yohei Matsui; Junji Uchino; Naoko Okura; Yoshie Morimoto; Masahiro Iwasaku; Yoshiko Kaneko; Tadaaki Yamada; Koichi Takayama

doi:10.2169/internalmedicine.7219-21

Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab

Intern Med. 2021 Nov 15;60(22):3585-3588. doi: 10.2169/internalmedicine.7219-21. Epub 2021 Jun 5.

Authors

Ryo Sawada¹, Yohei Matsui¹, Junji Uchino¹, Naoko Okura¹, Yoshie Morimoto¹, Masahiro Iwasaku¹, Yoshiko Kaneko¹, Tadaaki Yamada¹, Koichi Takayama¹

Affiliation

¹ Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.

Abstract

A 67-year-old man with primary lung adenocarcinoma was hospitalized due to massive bilateral pleural effusion and pericardial effusion after 94 cycles of nivolumab therapy. We were unable to identify the cause of these effusions using blood tests, cytology tests, or bacterial culture of pleural effusion and thoracoscopy. Finally, we administrated corticosteroids, which immediately improved the fluid accumulation. This case may support the introduction of corticosteroids for late-onset pleural and pericardial effusion during immune checkpoint inhibitor (ICI) treatment. However, the safety of rechallenge of ICIs after the improvement of fluid accumulation is controversial.

Keywords: immune-related adverse events; lung adenocarcinoma; nivolumab; pericardial effusion; pleural effusion.

Publication types

Case Reports

MeSH terms

Aged
Humans
Lung Neoplasms* / drug therapy
Male
Nivolumab / adverse effects
Pericardial Effusion* / chemically induced
Pericardial Effusion* / diagnosis
Pleura
Pleural Effusion* / chemically induced
Pleural Effusion* / diagnosis

Substances

Nivolumab