Salvage Pneumonectomy for Rapidly Progressive Destroyed Lung during Durvalumab Maintenance after Chemoradiotherapy

Durvalumab maintenance therapy following chemoradiotherapy is the standard treatment for patients with unresectable stage III non-small-cell lung cancer. Immune checkpoint inhibitors can alter host immunity, potentially amplifying inflammatory responses during opportunistic infections. We report a rare case of rapidly progressive destroyed lung caused by invasive pulmonary aspergillosis during durvalumab therapy, which was successfully managed with salvage pneumonectomy. A 53-year-old man with locoregionally recurrent lung adenocarcinoma received chemoradiotherapy followed by durvalumab treatment. Invasive pulmonary aspergillosis developed on day 74. Despite intensive antifungal therapy and corticosteroid administration, the right lung developed extensive liquefactive necrosis beyond the irradiated field within 5 weeks. Given the risk of fatal hemoptysis and sepsis, an emergency right pneumonectomy was performed. The frozen hilum required intrapericardial vascular control and reinforcement of the bronchial stump. Recovery was uneventful, and pathological examination confirmed aspergillosis without residual malignancy. Prompt recognition of medical refractoriness and timely surgery are critical for survival.