Fig. 3.

Pneumonitis with a COP pattern in a 33-year-old female with Hodgkin lymphoma treated with nivolumab and ipilimumab combination therapy (Patient 16), with a recurrence during retreatment and two episodes of pneumonitis flare after completion of corticosteroid taper.

A, B. The patient completed 2 months of corticosteroid taper and after one month, she experienced another episode of pneumonitis with a very similar radographic pattern, without nivolumab retreatment or other systemic therapy, indicating a pneumonitis flare.

C, D. Another course of corticosteroid taper was given and with subsequent improvement.

E, F. The 2.7-month course of corticosteroid taper was completed and after 2 weeks, the patient again developed a pneumonitis flare with a similar radiographic pattern as the prior episodes.

G, H. The sampled fragments of lung obtained by transbronchial biopsies showed interstitial pneumonitis evolving to organizing pneumonia. Findings included lymphocyte-predominant interstitial pneumonitis (arrowhead, O, H&E stain, 200X)with rare eosinophils (arrow, O), and areas of organizing pneumonia with fibroblast plugs and foamy macrophages filling the airspaces (asterisks, P, H&E stain, 200X). No tumor cells, microorganisms, or viral cytopathic changes were identified.

The patient started another course of prednisone taper with subsequent clinical improvement, and is schedule for a follow-up CT scan.