Images in a 69-year-old man with extensive stage small cell lung cancer
(SCLC) treated with first-line atezolizumab plus carboplatin and
etoposide. The patient also has a remote history of tracheal squamous
cell carcinoma, which had been treated with chemoradiotherapy. (A,
B) Chest CT scans obtained 6 weeks after initiation of
atezolizumab therapy demonstrate development of peripheral areas of
consolidation in the right lung (arrows in B), indicative
of immune checkpoint inhibitor–related pneumonitis with an
organizing pneumonia pattern. A dominant lung mass from SCLC is noted in
the right upper lobe (* in A), with underlying
postradiation changes from prior radiation therapy to the tracheal tumor
(arrow in A). The patient had increasing shortness of
breath but no fever, and results of infectious work-up, including
COVID-19, were negative. Atezolizumab was held and the patient was
treated with oral corticosteroids.