CTICasesImmunotherapy-Induced Organizing Pneumonia Evolving to NSIP
Imaging findings
Serial CT in a man on immunotherapy for metastatic cancer, viewed backward in time, shows the most recent study with a classic NSIP-like pattern of peribronchiolar fibrosis with traction bronchiectasis and some organizing pneumonia. Earlier studies show progressively more ground glass and less fibrosis, and the initial study, obtained a few weeks after starting the drug, showed a classic peribronchiolar organizing pneumonia. The airway distortion is mild overall.
Key takeaways
Immunotherapy-induced lung toxicity can begin as a classic organizing pneumonia and, over months, evolve into an NSIP pattern with traction bronchiectasis, a transition previously seen mostly with connective tissue disease but here attributed to drug toxicity. The drug was continued initially because of a dramatic tumor response and minimal symptoms, and worsening lung findings then prompted withdrawal and steroids, illustrating the risk-benefit balance in symptomatic monitoring.
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