CTICasesTrastuzumab-Induced Organizing Pneumonia in HER2-Positive Metastatic Colon Cancer
Imaging findings
In a patient with HER2-positive metastatic colon cancer started on trastuzumab, CT obtained after treatment initiation shows sub-segmental, patchy, predominantly consolidative ground-glass opacities; on a subsequent study weeks later there is a new focus of similar opacity in the right lower lobe with an atoll/reverse-halo sign, and overall increased lung involvement compared with the interim study.
Key takeaways
Patchy consolidative ground-glass opacity with an atoll sign developing after starting trastuzumab, without evidence of infection or another cause and in a clinically well-appearing patient, is consistent with drug-induced organizing pneumonia -- a reported complication of trastuzumab and of newer monoclonal antibody and immunotherapy agents more broadly, which are increasingly recognized causes of organizing pneumonia.
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