Acute respiratory failure (ARF) is the leading cause of ICU admission for immunocompromised patients.
While infectious etiologies remain the most common cause of ARF in these patients, there is an increasing prevalence of non-infectious, treatment-related causes.
Immune check-point inhibitors (ICIs) are now used with increasing frequency, and can cause severe pulmonary toxicity in approximately 6% of patients.
Pearls for ICI pulmonary toxicity include:
Acute pneumonitis is the most common presentation
Median time of onset of approximately 4 months after treatment initiation
Symptoms include dry cough, hypoxemia, and infiltrates not c/w CHF, infection, or progression of malignancy
Treatment is to DC the ICI and initiate steroids
References
Ferreyro BL, Munshi L. Causes of acure respiratory failure in the immunocompromised host. Curr Opin Crit Care. 2019;25:21-8.
