PMC8327228_01
Positron emission tomography (December 4th) showing disease involvement of left lung, left pleura, mediastinal, and left lung hilar lymph nodes and left adrenal gland.
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A Positron emission tomography-computed tomography (PET-CT) done 3 days later showed an FDG-avid lobulated left lung mass with pleural-based metastatic nodules, mediastinal and left lung hilar metastatic lymph nodes as well as left adrenal involvement (Figure 1).
Baseline chest computed tomography done on December 1st (left) and follow up imaging on December 15th (right) with evident increase in the size of the left lower lobe consolidation and multiple left pleural-based masses.
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Repeat chest CT showed an increase in the left lower lobe consolidation with appearance of multiple bilateral sub-centimetric pulmonary nodules (Figure 2).
December 17th: Imaging pre (left) and post (right) bronchoscopy, 12 days after pembrolizumab dose, showing complete left hemi-thorax opacification and confirmed by pathology to be tumor hyper-progression.
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CT chest was done on December 17th (12 days after Pembrolizumab) for worsening dyspnea, showed further increase in the left lung consolidation and enlargement of the pleural-based masses (Figure 3). CT-guided biopsy of one of the new masses was positive for adenocarcinoma with PDL-1 positivity in 70% of the cells.
Baseline eosinophilia before and after administration of pembrolizumab.. Abbreviation: AEC, absolute eosinophils count.. The dates in squares represent the first and second pembrolizumab doses.
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Of note, his eosinophil count continued to increase progressively to reach 6237/cu mm, despite his tapered steroid therapy (Figure 4).