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Eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis: case report A 71-year-old woman developed eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic airway inflammation during treatment with nivolumab and ipilimumab for metastatic renal cell carcinoma. The woman presented to hospital due to nasal congestion and cough for 2 weeks. She had been receiving first-line chemotherapy with ipilimumab 45mg and nivolumab 240mg every 3 weeks since last 2 months. After receiving two cycles, a chest CT scan findings were consistent with drug-induced interstitial lung disease. The woman’s chemotherapy was therefore discontinued. Within 2 weeks, a repeat chest CT scan revealed disappearance of infiltrate; however, mucus plugs and bronchial wall thickness was observed. Her medical history included childhood asthma, but she never experienced such respiratory symptoms. She was non-smoker. She did not used any other medications except anti-cancer treatment. Physical examination revealed rhonchi on the bilateral side, RR of 20 /min and oxygen saturation of 95% in room air. She underwent laboratory investigations including blood tests, sputum test, immunoglobulins and pulmonary function tests. These tests results were consistent with eosinophilic airway inflammation. Otolaryngological examination revealed nasal polyps with bilateral eosinophilic infiltration. A maxillofacial CT scan showed soft density shading prominently in her bilateral ethmoid sinus. Based on these examinations, she was diagnosed with ECRS along with eosinophilic airway inflammation. She received treatment with vilanterol/fluticasone furoate [fluticasone furoate/vilanterol trifenatate] for eosinophilic airway inflammation, and fluticasone furoate for ECRS. Subsequently, her nasal congestion and dry cough decreased, and her symptoms were under control. The woman’s chemotherapy with ipilimumab and nivolumab was resumed, and she received two more cycles without worsening of her symptoms. After a total of 4 cycles, maintenance therapy with nivolumab was given every 2 weeks. In two months, her fractioned exhaled nitric oxide decreased and forced expiratory volume in 1s improved in 2 months. Watanabe H, et al. Eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis during nivolumab and ipilimumab. Respirology Case Reports 8: No. 7, Oct 2020. 803504458 Available from: URL: http://doi.org/10.1002/rcr2.638

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Reactions 3 Oct 2020 No. 1824