PMC9078828_01
Line graphs depicting serial full blood count values over time over cycles 1-4. Eosinophils were the only subset of cells that elevated above normal range after cycle 1 before returning to normal at time of cycle 3. Normal ranges for haemoglobin (130-162), white cell count (4.3-11.2), platelets (150-400), neutrophils (1.90-7.90), basophils (0.05-0.10), monocytes (0.30-0.90), eosinophils (0.03-0.44), and lymphocytes (0.50-4.00).
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PMC9078828_01_CRIONM2022-2658136.001.jpg
fig1
On review of serial blood tests, an isolated raised eosinophil count of 0.47 x 109 first occurred 3 weeks after cycle 1 pembrolizumab and peaked at 1.1 x 109 coinciding with his admission postcycle 2 of treatment (Figures 1(a) and 1(b)) (autoantibody screen was not performed either pre- or on immunotherapy).
(a) Spirometry during acute admission with cough, wheeze, and shortness of breath. Spirometry indicates obstructive airways with raised FeNO supporting a process of inflammation in the airways. (b) Spirometry 6 months after acute episode requiring admission, values now normal including the FeNo.
CRIONM2022-2658136.002.jpg
PMC9078828_01_CRIONM2022-2658136.002.jpg
fig2
Spirometry during admission showed a FEV1 2.57 (91% predicted), FVC 4.04 (108% predicted), ratio of 64% (peak expiratory flow rate 94% predicted), gas transfer corrected 6.29 (78% predicted), and KCO 1.18 (93% predicted) (Figure 2(a)). Repeat spirometry 6 months later showed FEV1 2.61 (89% predicted), FVC 3.65 (95% predicted), ratio of 93% (peak expiratory flow rate 97% predicted), and FeNo 17 ppb (Figure 2(b)).