Diffuse Alveolar Hemorrhage With Avelumab Maintenance Therapy.

Area of Science:

• Oncology
• Immunotherapy
• Pulmonology

Background:

• Immune checkpoint blockade is a significant advancement in cancer therapy.
• Adverse events from immune checkpoint inhibitors (ICIs) are diverse and can mimic other conditions.
• Pneumotoxicity is a known complication of ICIs, posing diagnostic challenges, especially with overlapping symptoms from infections like COVID-19.

Observation:

• A patient with metastatic urothelial carcinoma received treatment with avelumab, an immune checkpoint inhibitor.
• The patient subsequently developed symptoms suggestive of lung injury.

Findings:

• The patient presented with diffuse alveolar hemorrhage (DAH), a severe form of lung toxicity.
• DAH occurred in the context of avelumab treatment for urothelial carcinoma.

Implications:

• This case underscores the importance of recognizing DAH as a potential immune-related adverse event (irAE) associated with avelumab.
• Early diagnosis and management of ICI-induced pneumotoxicity are crucial for patient outcomes.
• The complexity of diagnosing ICI-related lung injury necessitates a high index of suspicion, particularly in patients with pre-existing respiratory conditions or during pandemics.