Core IM | Internal Medicine Podcast #168 Immune Checkpoint Inhibitor Adverse Events 2.0: 5 Pearls Segment
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Jan 8, 2025 Explore the world of immune checkpoint inhibitors and their unusual, yet challenging, adverse events. Learn how to distinguish these reactions from infections, delving into issues like pneumonitis, colitis, and dermatitis. Discover the importance of early identification and the role of imaging techniques in diagnosing respiratory symptoms. Understand the long-term management of endocrinopathies, including hormone replacement strategies. Each case study reveals the complexities of treatment and the essential need for teamwork in patient care.
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Diagnosing Pneumonitis
- To diagnose checkpoint inhibitor pneumonitis, rule out infections and heart failure.
- Consider an ambulatory O2 sat, as oxygenation can plummet with exercise, like in PCP.
CT Scans for Pneumonitis
- CT scans may not definitively diagnose pneumonitis, especially in patients with pre-existing lung conditions or prior radiation.
- Ground glass opacities in lower lobes are common, but not specific.
Bronchoscopy and Treatment
- Bronchoscopy's role in diagnosing pneumonitis is debated; BAL results may be inconclusive even with infection.
- One patient improved after receiving both steroids and antibiotics, making it unclear which treatment was effective.