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Abscess Formation in Metastatic Brain Tumor with History of Immune Checkpoint Inhibitor: A Case Report
Takeshi Takayasu1, Fumiyuki Yamasaki1, Takeo Shishido2
1Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan.
Abstract:
We present the case of a 68-year-old man with brain metastasis from lung cancer and a history of immune checkpoint inhibitor administration, with overlapping abscess within the metastatic lesion. He initially received antibiotic treatment under a diagnosis of brain abscess because of a hyper-intense area on diffusion-weighted imaging inside the gadolinium-enhanced wall. The size of the enhanced lesion did not change much, but the extent of perifocal edema decreased after antibiotic treatment. After 2-4 months, the lesion gradually enlarged, and imaging characteristics changed from single cyst to multiple cysts. Surgical resection was performed and pathological examination revealed the lesion as metastasis from the lung tumor. Smear preparation of the tumor contents detected Gram-positive bacilli, confirming the dual pathology of metastasis and brain abscess. Discussing the pathogenesis, we speculated that therapy with durvalumab (MEDI4736), an anti-PD-L1 antibody, induced immune status modification including immunosuppressive regulation, which might have promoted abscess formation.
Insights
A brain metastasis from lung cancer presented as a brain abscess after immune checkpoint inhibitor therapy. Pathological examination confirmed dual pathology, suggesting immunosuppression promoted abscess formation.
Area of Science:
- Neuro-oncology
- Infectious Diseases
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICIs) like durvalumab (anti-PD-L1) are used to treat lung cancer.
- Brain metastases can complicate lung cancer treatment.
- Brain abscesses are infections within the brain parenchyma.
Observation:
- A 68-year-old man with lung cancer brain metastasis treated with durvalumab developed a lesion initially diagnosed as a brain abscess.
- Initial antibiotic treatment reduced edema but did not resolve the lesion.
- Over 2-4 months, the lesion evolved from a single to multiple cystic structures.
Findings:
- Surgical resection revealed metastatic lung cancer with coexisting Gram-positive bacilli.
- Pathological examination confirmed the dual pathology of metastasis and brain abscess.
- The patient's history of durvalumab administration was noted.
Implications:
- This case highlights a rare presentation of dual pathology in brain metastasis.
- ICI-induced immunosuppression may predispose to abscess formation within metastatic lesions.
- Further research is needed to understand the interaction between ICIs, brain metastases, and infection.
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