Pulmonary reversed halo cycles and consolidations after immunotherapy:A case report

BACKGROUND Immune checkpoint inhibitor-associated interstitial lung disease(ICI-ILD)and opportunistic pneumonias are the main pulmonary complications during immunotherapy for malignancies.The organizing pneumonia(OP)pattern is one of the common radiological manifestations of ICI-ILD,and OP is the most common cause of reversed halo cycles and consolidations.However,opportunistic pneumonias should be excluded.CASE SUMMARY In this report,we described a case of a 44-year-old man with esophageal cancer who showed multiple reversed-halo cycles and consolidations on chest computed tomography(CT)after he had a cold during immunotherapy.He was diagnosed with esophageal squamous-cell cancer(T2NIM0)after surgery.Then,he was successfully treated with 6 cycles of chemotherapy plus tislelizumab,one cycle of radiotherapy and 9 cycles of tislelizumab.Two months later,he complained of low-grade fever and cough with nonpurulent sputum after he had a cold.Community-acquired pneumonia was considered,but moxifloxacin was ineffective.Chest CT showed multiple reversed-halo cycles and consolidations.Mycobacterium tuberculosis was identified with next-generation sequence analysis of bronchoalveolar lavage fluid(BALF).Two months later,he improved with standard anti-tuberculosis medications.Both the cycles and consolidations disappeared in the repeat CT after 6 mo of medications.CONCLUSION When chest CT shows reversed-halo cycles and consolidations in patients during anticancer immunotherapy,both ICI-ILD and infectious pneumonia should be considered.BALF microbiological analysis was helpful to differentiate them.