Other factors associated with severe COVID-19 resulting in in-hospital mortality are increasing age and male sex. This is in contrast to the case fatality rate of COVID-19 in general, which was initially thought to be 15%, but in countries with rigorous testing appeared to be much lower at 0.3% ( 3).Ĭomorbidities were found in 77% of patients who died of severe COVID-19, with the majority being cardiopulmonary, liver or kidney disease, obesity, dementia, but also malignancy ( 2).
The in-hospital mortality is reported to be up to 25% ( 2). However, some patients experience a severe pneumonia, with acute respiratory distress syndrome (ARDS) and sometimes multi-organ failure. Symptoms of COVID-19 can be similar to a common cold such as fever, coughing and shortness of breath. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has infected 10 million people and caused half a million deaths as of June 30th, 2020 ( 1). This algorithm may be a supportive tool for clinicians to diagnose the underlying cause of the pneumonitis in patients treated with ICI during this COVID-19 pandemic. We summarize the clinical, radiological features as well as additional investigations of both entities, and suggest a diagnostic algorithm for distinction between the two. Therefore, distinction between these two entities is warranted. It has been speculated that immunosuppression may be associated with increased risk of progression to severe COVID-19, especially during the early stage of infection with SARS-CoV-2. The mainstay of treatment in ICI pneumonitis is immunosuppressive therapy, as this is a potentially fatal adverse event. For the latter, dexamethasone and remdesivir have shown encouraging results, while vaccines are currently being evaluated in phase III trials. Symptoms and radiological features of ICI pneumonitis can be overlapping with those of COVID-19 related pneumonia. In patients with cancer treated with ICI who present at the emergency department with respiratory symptoms during the COVID-19 pandemic, correct diagnosis can be challenging. Cancer has been reported to be one of the risk factors for severe coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that has engulfed the world in the last couple of months. ICI-induced pneumonitis is a serious complication seen with treatment with these agents.
Immune checkpoint inhibitors (ICI) have become the standard of care treatment for several tumor types. 4Department of Pulmonary Medicine, Maastricht University Medical Center, Maastricht, Netherlands.
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